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Wilson, Robert Morriso 


The care of human 














Wilson, Hobert lorriaon, 1860- 

The care of human machinery, by R, M, Wilnon..^ 
London, Frowde, 1^21 • 

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M.B., Ch.B., Late Temp. Capt. R.A.M.C. 






192 I 

Printed in Great Britain hy R. tl' R. Ci.ark. I.imh ki>, Rdinburgh. 




Mr. T. S. sheldrake 
in token of estkem and admiration 


Industrial Medicine is a science in its babyhood. 
It is a lusty baby. Already the doctor appears as 
the friend of employer and employed, showing how 
these may reconcile their differences in the Hght of 
scientific facts. The object of all industry is output. 
This can be secured in full measure only by healthy, 
happy, "human machinery." So that the good 
employer is also the prosperous employer, the healthy 
employee also the good one. Here is a new basis for 
the settlement of industrial disputes. 

In the following chapters the elements of the 
subject are set forth in language as simple as possible, 
since the volume is intended not only for medical 
men, but also for employers of labour and their 
workers. The writer desires to thank The Times 
Publishing Company for permission to reproduce 
material appearing in their Trade Supplement, and 
to the Editor of that Journal he tenders his warmest 
regards. That Industrial Medicine has made the 



rapid strides achieved by it in this last year is due, 
in no small measure, to the foresight and encourage- 
ment of the Editor of the Times Trade Supplement, 
who early recognized the meaning of the new move- 
ment, and who lent to it all the weight of his great 

authority and influence. 


London, December 1920. 



Industrial Fatigue 

• • 



Unprofitable Output 


The Hours op Industry 

• • 



The Human Machinery . 



The Problem of Lost Time . 

• • 



The Lost Worker 


Women in Industry 


. 71 




Juvenile Employment 

The Price of Disease 

• • 

• • 


Waste in Movement 


Ventilation and Output 


Tuberculosis in Industry 


Problem of Venereal Disease 




• • 



• • 




Eye-Strain in Industry . . . . . .146 


The Dust Peril 








Safety First ^^^ 

First Aid ^^^ 


Noise in Industry . . . . • • .191 

Industrial Welfare 205 



Food of the Worker . . . • • ,213 


National Physical Education .... 220 


America's Programme . . . • • .227 

INDEX 235 



The problem which faces every employer of labour 
to-day is how to maintain or increase his output 
and at the same time fulfil or improve upon the 
requirements of the law with regard to the wages, 
times of work, and general treatment of his 
employees. His fear is, as each fresh demand for 
shorter hours of labour is made— no reduction of 
wage being contemplated in connexion with the 
demand— that, if it be acceded to, his margin of 
profit must shrink. Consequently he is apt to 
adopt an uncompromising attitude and to tell his 
employees that if they persist in their claims he 
will be forced to shut down altogether. 

This standpoint is comprehensible, but it does 
not follow that it is reasonable. It may, on the 
contrary, be unreasonable when modern scientific 
work on hours of labour and fatigue is taken into 
account. It may even be suicidal, for just lately 
science has cast some strange light upon the darker 
places of industry. 

When the munition factories were established it 

1 B 


was decided to set up in connexion with them a 
committee of expert men of science to carry out 
research into industrial efiiciency from the point of 
view of the employer and the employed. The first 
subject which this committee investigated was 
" fatigue " ; and the results obtained were of a 
remarkable character. Let us put the matter 
broadly in a simple illustration. 

A group of five male voluntary workers were 
able in a certain factory in eight hours (or seven 
hours free of meals) to exceed the average day's 
output of eight men, who worked fourteen hours 
(or twelve and a half hours free of meals). Though 
it was admitted that the five men worked at a 
" sprint " and could not, probably, have maintained 
this daily, nevertheless it was proved that on four 
days a week they could easily repeat their per- 

The starthng result emerged that these men 
could do in four days rather more than the whole 
week's work of an equal set of men adopting the 
other system of hours. Moreover, they could, while 
exceeding the output of the every-day-and-all-day 
group, enjoy longer nights, have more recreation 
in each working day, and have three whole hoUdays 
in each week. 

The conclusion was drawn that " the paid week- 
day workers at this factory who have been working 
their long hours for many months might have 
greatly improved both their output and their com- 
fort under a better-chosen system of special efforts 
alternating with suitable rests." The work in 



question was work of a uniform " repetitive " kind 
involving moderate physical exercise. 

In another factory a fact no less striking was 
elicited quite by accident. The factory was an 
old-established one, to which it was proposed to add 
a new shop of a size sufficient to produce 5000 
articles per week — this estimate of capacity for 
output being based on the whole experience of the 
business. New hands were engaged for the new 
shop. They were somewhat inexperienced. Yet, 
to the amazement of every one, after six months, 
while the experienced hands in the old shops were 
producing 5000 articles per week, the inexperienced 
hands in the new shop produced 13,000 articles 
per week. All the mechanical conditions of work 
were identical, not only in this factory, but also in 
other similar factories, yet nowhere did older hands 
approach this output of the new men. The com- 
ment was made by the scientists who investigated 
the case, " the lower output by the more experienced 
hands appears to be assignable only to the effects 
of long-standing customary restrictions upon habits 
or rhythm of work from which the newer hands 
are free." In other words, fatigue crept in in the 
one case, while it did not creep in so soon in the 

Fatigue, then, is a matter of great economic 
importance, and a knowledge of its nature, causes, 
and the means of avoiding it has become vital to 
every enlightened employer at the present moment. 
For work done while fatigue is present is inferior 
work, wasteful work. The employer is paying full 


wages for it and he is obtaining less than value for 
his money. 

Fatigue, indeed, is indicated by a diminished 
capacity for doing work. This is the real economic 
meaning of the state, and any other definition should 
be ruthlessly excluded by those who are considering 
it from the business point of view. Moreover, the 
bodily sensations which are commonly associated 
in the pubUc mind with fatigue are misleading. 
These bodily sensations are a late manifestation, 
and fatigue — that is, industrial inefficiency — may 
be present and may be developed to a high degree 
without there being any bodily manifestation of 
" tiredness " at all. In other words, the man may 
appear to be, and may feel, quite fresh ; yet, as 
judged by his capacity for output, he may be suffer- 
ing from industrial fatigue of a marked character. 
His employer is thus wasting his money ; he is 
paying for that which he cannot possibly receive. 

The reason for this distinction between what 
the layman calls fatigue and what the modem 
employer in his own interest should recognize as 
that state is to be found in the nature of the bodily 
mechanism whereby work is accomplished. We 
make no excuse, therefore, for giving an outhne of 
this mechanism. 

The performance of work depends on several 
factors — the senses and the nerves which connect 
these with the brain, the brain itself, the nerves 
which carry the messages of the brain to the muscles, 
and finally the muscles. The popular idea of fatigue 
as " tired muscles " is altogether too restricted. 


The muscles may not be tired at all (they very 
seldom are), and yet the nervous system which 
controls them may be exhausted to such a degree 
that working capacity is reduced far below normal. 
Indeed, so far as industrial fatigue is concerned, 
the seat of action is rather on the nervous than on 
the muscular side. The fatigued worker is in some 
ways comparable to a motor engine running with 
a choked exhaust pipe. There is plenty of power, 
but the means of realizing the power are deficient. 
It is not lack of fuel wliich is the trouble, but rather 
it is a clogging of the wheels with dirt — the wheels, 
in this case, being the nerves and brain. 

Every activity of the body is attended by the 
production of waste products, which must be removed 
if the body is to maintain its working efficiency. 
These waste products are normally carried off by 
the blood, in part as the result of a process of irriga- 
tion and in part by chemical means. Thus rest, 
after activity, is not a mere passive process. It is 
an active process just as work is. The engine has 
gone to the sheds to be cleaned, repaired, replenished. 
Time is clearly essential to the carrying out of this 
active process of recreation. A rule emerges : 

"There will be a definite relation between the 
degree of any given activity and the time necessary 
for the completion of the subsequent restoration 
process. If the activity is repeated too quickly to 
give time enough for restoration after each action 
fatigue will become progressively more intense as 
the debit balance accumulates, and each repeated 
act in consequence will be more and more impeded 


and will become smaller until further action is 

It has been found by careful experiment that, 
so far as the nerves and nerve fibres, which connect 
the outside world with the brain on the one hand 
and the brain with the muscles on the other, are 
concerned, fatigue does not occur. At least, fatigue 
here is unrecognizable, probably because of the 
extreme speed with which nerves recover their full 
activity. As regards the brain, however, the matter 
is quite otherwise ; indeed, it is certain that the 
"receiving and distributing mechanisms" of brain 
and spinal cord become clogged up and so fatigued 
in the industrial sense considerably earUer than do 
the muscles themselves. It is thus true that the 
muscles are protected from great fatigue by the 
brain, for the latter cannot force them to act until 
they are completely exhausted. The brain itself, 
before this point is reached, is rendered incapable 
of giving any orders. Industrial fatigue, that is, 
a state of diminished capacity for effort, is therefore 
fatigue of the brain, though, in sensation, its effects 
may be referred to the muscles. The man may, 
and often does, feel that his muscles are exhausted ; 
in reaUty it is his brain which will work no more. 
On the other hand — the common case — he may, 
as we have pointed out, feel no sense of exhaustion 
and yet be suffering from a measure of fatigue 
which renders him a very bad investment so far as 
his employer is concerned. 

This truth can be better understood when it is 
reahzed how a change of work will often banish a 


sense of exhaustion which has come on during the 
performance of a particular task. The same muscles 
as were employed in the old are used agam in the 
new activity. But now they feel fresh and eager 
once more. What has happened is that a new part 
of the brain has been called into play for the new 
effort Fatigue has miraculously disappeared. In 
the same way a tired man walldng by himself along 
a road wiU often, if he is joined by an interestmg 
companion, lose all sense of tiredness and become 
completely refreshed— a new part of his bram has 

been enlisted. 

It follows— and here is the big pomt for the 
employer— that a break in one form of work and a 
transference to another form of work may up to a 
point convert an industrially fatigued man mto a 
fresh one, or, better still, may prevent the onset 
of fatigue and maintain full working efficiency over 
a considerable period of time. 

Indeed, the problems of industrial fatigue are 
almost wholly problems of fatigue in the nervous 
system. The ceUs of a particular part of the bram, 
or rather of a particular " path " in the brain, have 
become overworked through handling too many 
messages. They are like a series of tired telephone 
girls ; they lose their alertness, they respond slowly 
to calls made upon them, they become incapable 
of the speed and deftness upon which a high rate 
and quaUty of output depend. They must be 
cleansed and restored. ^^ 

Meanwhile another set of cells, another " path 
in the brain, another group of telephone girls can 


be called into play. These are relatively fresh and 
so may command the still unexhausted muscles 
with excellent effect. 

In popular phrase, the man can " switch off " 
one form of activity and " switch on " to another, 
maintaining by this means, throughout a long 
period, his fullest efficiency. Whereas had he tried 
to carry on the first task only throughout the same 
period^ his working efficiency would have been 
seriously impaired and he would have become, 
during the latter hours of his labour, a poor invest- 
ment for his employer's money. 

We may now look at the subject more closely 
and grasp the fact that the principles we have 
enunciated depend on fundamental natural laws, to 
reckon with which is to succeed, to fly in the face of 
which is to court disaster. In nature, if we may so 
put it, great fatigue does not normally occur. That 
is to say, an overdraft on the bank of strength is 
not permitted. There is for every acting element 
" a given rhythm of activity which allows exact 
recovery after each act," and maintains the balance 
between action and repair throughout a long series. 
The heart is a splendid illustration of this. It will 
go on beating throughout a long fife without loss of 
working capacity because the period of the beat 
and the periods of rest between the beats are so 
nicely adjusted that the organ is kept continually 
refreshed and restored. 

There is reason, though, to think that this rest 
and action in the case of the heart — as in the case 
of other muscles — is regulated in the nervous system 


and not in the heart muscle itself. In other words, 
that part of the nervous system governing the heart's 
action dictates the rhythm of the heart in accordance 
with its own and the body's requirements. The heart 
muscle itself probably does not therefore reach 

fatigue at any time. 

This is far more important than might appear at 
a first glance. For not only does it throw a new fight 
on those cases of " debifity " and *' weakness " 
which are the bane of every working organization, 
but it explains why fatigue occurs more quickly 
in one man than in another, why training wiU post- 
pone the onset of fatigue, and why, by a combina- 
tion of judicious selection of employees and proper 
care of them when selected, maximum work can be 
obtained with minimum exertion. 

So long, in fact, as employers "thought in 
muscles," that is to say, thought of a man as having 
a certain amount of strength to expend, and as being 
able to expend it at the same level aU the time, so 
long did they seem justified in acting as if the pro- 
cesses of the body had no bearing on their profit 
and loss account. The moment that " thinking in 
muscles " gives place to " thinking in brain ceUs " 
the whole situation is changed. Each ceU has its 
rhythm of action and rest, and the nearer to these 
cell rhythms the hours of labour, the pace of machin- 
ery, and so on, are brought, the more effective and 
sustained will be the work done. 

If the rhythms imposed from without are faster 
than the natural rhythms of action and rest, they 
must result in accumulated fatigue. Consequently : 


*' It is the problem of scientific management to 
discover in the interests of output and of maintained 
health of the workers what are the ' maximal effi- 
ciency rhythms ' for the various faculties of the 
human machine." 

Once these are determined, " pace " can be 
regulated so that fatigue is warded off as far as 
possible, and so that working efficiency is kept to 
its highest possible point during the whole period 
of work. 

In order that employers may realize that these 
are no academic speculations but matters vital to 
industry, we may now come to consider some of the 
tests for fatigue. The first of these which was used 
by Dr. Stanley Kent during his studies on munition 
workers consisted in a method for determining what 
is known as " reaction time " — that is to say, the 
time which elapses between the receiving by the 
employee of a call for action and his response to 
that call. It is easy to see that the essence of efficient 
work is a short reaction time ; the worker who is 
setting type, for example, carries out a series of 
movements which are dictated by the impressions 
conveyed to him by his eyes. The time which 
elapses between the point when he sees the letter 
to be " set " and the point when he actually sets it 
is his reaction time for this visual impression. If he 
is expert and fresh this time will be exceedingly 
short, it will lengthen as he becomes fatigued, until 
finally he must — if the process is continued — prove 
an unprofitable investment for the person paying 
him wages. 



One of the tests used was as follows : The man 
being examined was required to depress a key which, 
at the same time that its movement was recorded 
on a revolving drum, closed an electrical circuit and 
caused a shutter to fall. This exposed a letter or a 
particular colour. The man had to recognize this 
letter or colour and then to select from six keys in 
front of him the one bearing a similar letter or 
colour to that exposed and to depress it. The result 
of depressing this second key was to produce a second 
mark upon the drum. The distance between the two 
marks — the rate of the revolution of the drum being 
known — was the reaction time for this complicated 


The accompanying figure (Fig. 1) illustrates the 
result of this test in a man employed in a munitions 
factory. The fkst value given, Monday's, is above 
zero, and so indicates that the reaction time in the 
evening was shorter than in the morning. In other 
words, this man was actually less fatigued when he 
stopped work on Monday than when he began to 
work on that day. It is pointed out, however, 
that Monday is a peculiar day in this respect, for 
a period of forty-two hours' rest had elapsed since 
the last work had been done, this period having the 
double effect of making the worker slightly " rusty " 
and also refreshing him. By Monday night he had 
returned to his old " form " and had not yet passed 
beyond the good effect of his rest. 

Tuesday, which was a day of " overtime," saw 
a marked change. The point is now below zero, 
indicating that the reaction time was longer in the 


evening than in the morning (by 42-lOOths seconds 
in point of fact). The same thing occurred on 
Wednesday, also an overtime day. But on Thursday, 
when overtime was not worked, the morning and 
evening reaction times were about the same, in- 
dicating that fatigue had not occurred. Friday, an 

Points above Zero indicate Evening Reaction 
Time quicker than Morning . 

Mon. Tues. Wed. Thur. Fri Sat. 

Morninq ReactionTime quicker than Evening 

indicated by points below Zero. 
A Fall of the Curve indicates the development of ktigu? 
Overtime Days ...Thus mM 

Fig. 1 (after Kent). 
The graph refers to "reaction time," or rate of response. 
When this was shorter in the evening than in the morning the 
line is above zero, when longer it is below. 

overtime day, at once lengthened the evening 
reaction time again, indicating fatigue. On Satur- 
day, 12 noon, with the half -day work and the 
promise of rest, the fatigue disappeared and the 
man was better on quitting work than when he 


In the second figure a different method of charting 
has been adopted. The differences between morning 





and evening are not given as above and below zero, 
but are set forth quite straightforwardly as ups and 
downs, up being a shorter reaction time and down 

a longer one. 

Here again Monday shows no indication of the 
development of fatigue during the day, but, on the 
contrary, improvement. During the night, however, 
the opposite effect is seen. Overtime leaves the 



AFglloFthe Curve indicates the development of Fatigue. 
Overtime Days. ...Thus mlh 

Fig. 2 (after Kent). 

man with longer reaction times at the end of 

each day. 

The reaction times for hearing and for sight alone 
were also taken, and the results were similar to 
those obtained for the more complex effort we have 
described. It is consequently evident that on the 
days overtime was worked in this factory the men 
were suffering from fatigue during a portion of their 
working hours. Their reaction times were longer, 
and consequently their efficiency as workers was 
lower. The meaning of this and its bearing upon 



industrial accidents will be clearer when it is realized 
that the Royal Air Force refused to accept candidates 
whose reaction times were much above normal, as 
it was found that these men made bad aviators and 
were exceedingly apt to " crash." 

This test of reaction time is a test of the nervous 
system, not of the muscles. This must be firmly 
grasped. It forms an indication of fatigue which is 
of vital importance because it has stood the test of 
practical apphcation, as we shall show latter. The 
employer, therefore, who keeps men at work until 
their reaction times become abnormally long cheats 
himself, inasmuch as he pays for what he cannot 
obtain. If he engages men, in the first instance, who 
through disease or other defect have abnormally 
long reaction times he also cheats himself. This 
has, of course, been understood roughly ever since 
man began to do work at all, and employees have 
been divided into quick and slow manipulators and 
so on. But science now offers precise tests to replace 
the rough and ready methods of other days. It is 
a safe prophecy that just as no insurance company 
could afford to dispense with medical examinations, 
so no great employer of labour will be able in the 
near future to dispense with the help which physio- 
logy and medicine can give him in this respect. 





In the last chapter we gave grounds for the view 
that overtime labour is extravagant in the sense 
that payment is made for what cannot be obtained. 
We may now come to the more practical side of the 
subject and examine such figures as are available 
regarding the effect of fatigue with its prolonged 
reaction times upon actual output. 

The material before us is that collected by Dr. 
Stanley Kent. While his figures refer to fatigue 
other factors certainly play a part in their produc- 
tion, for example, the circumstances of the worker, 
his skill, his physical condition and general health, 
his food, his mental condition, and so on. The 
experiments were made upon winders, surgical lint 
packers, and boracic lint packers. 

The work in the winding room began at 6 a.m. 
and went on till 8 a.m. Half an hour was then 
allowed for breakfast. The next period of work 
was from 8.30 a.m. till 12.30 p.m., when there was 
an hour for dinner. From 1.30 p.m. till 5.30 p.m. 
work was carried on again. Those working over- 



time now took half an hour for tea, which was 
provided, and then continued working till 8 p.m. 
The work took considerable exertion and great 
manual dexterity. Constant standing was necessary. 
The duty of the worker was to replace bobbins 
working on a row of spindles as they became empty, 
and to replace reels on another row as they became 

Illustrating the efFect oF fatigue 
upon output in winding bobbins. 





8 pm. 

12 noon 

8 a.m. 

Fig. 3 (after Kent). 

full, to tie up broken yarn ; the area covered by each 
worker was some 31 bobbins with corresponding 
reels. The worker had also to handle the baskets 
bringing new bobbins to the machines. The con- 
stant reaching over and removing of the reels is 
described as "by no means Ught work." Tying 
the ends of the yarn when it broke required great 
dexterity. The work was paid for at piece-rates. 
A chart (Fig. 3) is given showing the average 



number of bobbins per hour emptied by four workers 
on Monday and on Saturday of the same week. 
The actual figures are : 

6 A.M. to 8 A.M. . 
8.30 A.M. to 12.30 P.M. 
1.30 P.M. to 5.30 P.M. 
6 P.M. to 8 P.M. (overtime^ 


Tuesday's figures were very similar. On Friday 
a higher level was attained though there was a 
fall during overtime. On Saturday the curve rose 
sharply. At the beginning of the week output was 
lowest during the early morning period. As the 
week progressed output during the early morning 
period improved, while, especially toward the end 
of the week, output declined during overtime. 

These results were confirmed during a second 
experiment, and they tally in a remarkable way 
with the results obtained in other directions and 
by repetitions of the experiment (Fig. 4). Thus 
there is revealed in each day a double periodicity 
of low outpu1>— the early morning and 6-8 o'clock 
in the evening. A comparison between the average 
figures for these low output periods and those for 
the two higher output periods on Monday and 
Tuesday of one of the experimental weeks shows : 

Bobbins per hour 

Low Output 


High Output 


This represents a difference of no less than 56-60 

bobbins per hour, or 678 bobbins per day. 


Saturday's high readings are explained by the 
approach of the week-end and the need of clearing 
the machines. When overtime was undertaken on 
this day (till 4.50 p.m.) the output fell very rapidly 
owing to the week's accumulation of fatigue. 

The question at once arises : " What would 
happen if the working day were to begin at 8.30 

crik ||lust:rattnq the eFFect oF Fatigue 

C 3 


upon output in_winding bobbins 


Fig. 4 (after Kent). 

instead of at 6 a.m. ? Would the unsatisfactory 
output be transferred to the later period or would 
it disappear ? " 

The matter was put to the test of experiment. 
Members of groups of workers began work some- 
times at 6 A.M. and sometimes at 8.30 a.m. The 
following examples show the kind of results obtained. 

No. 8 (winder) began work at 6 a.m. on Monday 





and at 8.30 a.m. on Tuesday. The rate of working 
was 209 bobbins per hour when she began at 6 a.m. 
It was 262 bobbins per hour when she began at 

8.30 A.M. 

No. 14 (winder) began at 8.30 a.m. on Monday, 
her rate being 221. The average rate for the group 
in the 6 A.M.-8 a.m. period*was 186. On Tuesday 
the same worker began at 8.30, her rate being 227. 
The average rate for the group for the 6-8 period, 
Tuesday, was 187. 

General averages in bobbins per hour for the 
6 A.M.-8 A.M. periods for five weeks were : 216, 253, 
258, 261, 226. For the period 8.30 A.M.-12.30 P.M. 
for one week when early morning work was suspended 
the average was 316, or 55 bobbins per hour above 
the best figure of the early morning numbers. This 
can be shown in another way, as in the following 
table, from which it will be seen that the suspension 
of the early morning work not only cut out a period 
of low output, but also increased the output in later 
periods : 

Week before early morning 
period was suspended 

Week during which early 
morning period was sus- 
pended .... 

Weekly Average 

Bobbins per hour 

for period 

6 A.M.-8 A.M. 


Weekly Average 

Bobbins per hour 

for period 

8.30 A.M.- 

12-30 P.M. 


Thus the early morning period may, in Dr. Kent's 
view, be said to bear the same relation to the labour 


of the day as Monday does to the labour of the 
week : 

" In both cases a cessation of work has produced 
a disinclination to recommence, to overcome which 
a distinct effort on the part of the worker is 

What has happened is that the worker has got 
out of practice. Practice is necessary at the 
beginning of every period of work, the amount 
required depending on the duration of the preceding 
period of rest. On the other hand, fatigue, carried 
over from the day before, also plays a part, since by 
cutting out the early morning period a greater out- 
put can be secured on several days at least of the 
week, though notably not, as a rule, on Monday. 

The employer is thus faced with a double problem. 
He must not, if he can help it, employ fatigued 
workers, because, if he does, he will get a smaller 
output than he might obtain with fresh ones ; at 
the same time he must avoid prolonging unduly 
the periods of rest, because if these are too long 
the level of " practice " will fall and a low output 

In this respect it is necessary to deal, not with 
weekly averages, but with individual days of the 
week. For example, Monday is a day on which 
early work is probably economically sound. The 
workers have had a prolonged rest, and are not at 
all fatigued. But they are considerably out of 
practice. It has been found that if the early hours 
of work (6 A.M.-8 a.m.) are cut out on Monday the 
output of later periods of the same day will suffer 





because the lack of practice will remain, no matter 
when the work is begun, and will have to be over- 
come. From Wednesday onwards, however, this 
lack of practice becomes neghgible. Much more 
important is the presence of accumulating fatigue. 
Therefore from Wednesday onwards it pays to cut 
out the early morning hours. 

A further illustration of this is afforded by the 
following table, which deals with a group of workers, 
and is expressed in bobbins per hour : 

Early Morning and 




Early Morning 


In one case a worker, on piece-work, found out 
for herself that it was profitable to avoid overtime 
and to cut out early hours. She usually worked 
only eight hours a day instead of twelve', and when 
asked the reason replied that the extra rest enabled 
her to work so much more quickly during the day 
that she was easily able to make up for lost time. 
Observations were carried out for twenty-five work- 
ing days on this worker, and her output was con- 
trasted with that of three of her companions who 
worked twelve hours a day. 

For the whole period of the experiment the total 
bobbins wound by the eight-hour-day worker was 
52,429. The average of the other three twelve- 
hour-day workers was 48,529. Thus the eight-hour- 
day worker was 7-5 per cent to the good. 

It will thus be seen that, measured by the standard 




of output, overtime and early hours during most 
days of the week were a failure. 

Nor did the evil stop there. A man's health 
depends on his leisure. If he is uneconomically 
employed doing a twelve-hour day he cannot devote 
the necessary time to recreation. He deteriorates 
both as a man and as a worker. Consequently, the 
employer's loss in him increases progressively. 
The training in his work he has obtained, which had 
he been quite healthy nftght have been expected 
to improve with time and so become more valuable 
to his employer, is counterbalanced by diminished 
working capacity. A kind of vicious circle is estab- 


Fatigue, then, whether of the moment or carried 
forward from yesterday, is the great enemy of out- 
put just as it is the great enemy of^ health and 
pleasure and joy in Hfe. It defeats aUl^e the object 
of employer and of employed and is equally danger- 
ous to both. The interest of the man is identical 
here with the interest of his master, and science 
comes as the friend of both. The enUghtened 
employer, acting even on the most commercial 
motives, will see to it that he abolishes this enemy 
of his pocket from his factory. Acting upon higher 
motives he will be still more determined in such a 
course, for he will perceive that happy, contented, 
and vigorous workpeople are of the very essence of 
commercial success. 

These remarks apply to healthy men and women. 
From work which has been carried out in other 
directions there has emerged the certainty that in 



the unhealthy, fatigue is much more readily mduced 
and much more lasting in its effects. Consequently, 
we must now discuss the question of the medical 
examination of employees. 

It is a far more difficult question than is generally 
supposed or allowed, because involved in it are some 
of the most recent researches into physiological 
medicine, researches which are only now emerging, 
if we may so put it, from the embryo stage. How- 
ever, a few simple propositions may be set forth 
in order to show the Unes of thought which are Ukely 

to repay following up. 

In the first place we must return to our previous 
statement that fatigue is a phenomenon of the 
nervous system, and not of the muscles. It is the 
nerve cells, or the nerve endings in some cases, 
wliich are tired ; it is not the muscle fibres. Con- 
sequently, poisons which act upon the nervous 
system are direct inducements to the onset of fatigue. 
The poisoned man, the sick man, is thus an un- 
profitable investment from the outset. 

This of course, is obvious when we are dealing 
with gross disabiUty. It is much less obvious and 
therefore much more important when we are dealing 
with men and women in the earUest stages of disease, 
before gross disabiUty has shown itself. We make 
no apology for going very thoroughly into this 


Disease, as understood by the pubhc, means 
something which lays its victim aside. But disease 
as it wiU come to be understood in the industrial 
world means something much more subtle. It 

A- 1 



means the presence in the body of some poison which 
is not eUminated, and which goes on, day by day, 
reducing the " margin of strength," that is to say, 
the working capacity of the individual affected. 
It is thus the most costly of all enemies of industry 
and the most ubiquitous. 

Let us take as a gross example the condition 
which is known popularly as " rheumatism." This 
in the pubHc mind consists of certain pains in the 
muscles, a tendency to headaches, occasional " biUous 
attacks" perhaps, and a host of small, ill-defined 
symptoms. This disease is widespread and its 
true character is only just beginning to be under- 
stood. It is now recognized that, strictly speaking, 
there is no such thing as " rheumatism." Rheu- 
matism is a name for symptoms, not a name for a 
fundamental disease. Almost all chronic diseases 
produce sooner or later rheumatic symptoms. For 
example, patients with dirty throats are very fre- 
quently afflicted with " rheumatism " from the 
poison coming from their throats. When their 
tonsils are removed their rheumatic pains disappear. 
The same appUes to bad teeth, to those whose 
bowels have become sluggish, to those who have 
suffered from some acute illness which may not 
have been got rid of from the system, e.g. diphtheria, 
consumption, rheumatic fever, and so on. PatieMts 
with chronic malaria — and there are many thousands 
in England at this day — are notoriously liable to 
suffer from rheumatic pains, so are chronic dysentery 
and chronic trench fever patients. These men, in 
short, are the victims of a slow poisoning, and they 



will continue to suffer until such time as the source 
of the poison is discovered and, if possible, eradicated. 

Now, from the industrial point of view, the mere 
" pains " might not seem to matter very much. 
That has long been the prevaiUng opinion, and the 
fact that it has been the prevailing opinion accounts 
for the difference that exists concerning this matter. 
But, in pomt of fact, these " pains " are of far more 
importance than appears at first sight. They 
indicate, to the initiated, the presence of an agent 
which, day in and day out, is sapping away the 
vigour that should be at disposal for productive 
work, for output. 

Let us see how the poisons operate within the 
body. It has recently been discovered and estab- 
lished as a strong probabiHty that the poisons of 
disease act directly upon the nervous system, and 
that extremely small quantities of these poisons are 
sufficient to throw that system out of gear, to fatigue 
it, in short. Consequently, the very first symptom 
of the invasion of the body by a poison is a sense 
of exhaustion. 

The various organs of the body, including all the 
muscles, are under nervous control. Not only so, 
but the blood-vessels which supply these organs are 
also under nervous control. When an organ is 
active the "sluice-gates" of its blood supply are 
thrown open by the nerves to its blood-vessels and 
at the same moment blood is driven out of other 
areas of the body and brought to the scene of action. 
The efficiency of any effort depends on a rapid and 
deft action of these various nerves. If for any 






reason the nerves are poisoned so as to be over- 
excited, or under-excited, the mechanism breaks 
down and the easy task of yesterday becomes the 
impossible task of to-day. 

We may prove tliis, for example, by observing 
a patient who is suffering from, say, chronic poison- 
ing from the teeth. This man will be of a " nervous " 
disposition. He will tend to be excitable, to react 
strongly to sUght causes, to sweat easily, to flush 
and pale at small provocation. He will be subject 
to tremors, to headaches, to rheumatic pains, and 
so on. If he be asked to draw a long breath and 
hold it, his pulse will slow to an abnormal extent, 
or else perhaps lose volume altogether. 

This latter test, a new one, is important, because 
it reveals a failure of the nervous system to com- 
pensate quickly for a sudden change of blood dis- 
tribution—in other words, the nervous system is 
poisoned, its balance is upset, responses and " re- 
action times " are disorganized. 

This man belongs to the order of the chronically 
tired. He cannot undertake much exertion with- 
out great discomfort. He lacks staying power. 
He is a bad investment. He is, indeed, normally 
half-fatigued, and his rate of output is Ukely to be 
below that of a man who is not poisoned and so has 
no need to expend his strength in fighting an in- 
sidious foe within his own body. 

Now it is quite clear that to employ such a man 
is uneconomic. His nerve cells are always in a 
state of fatigue— the first sign of fatigue is irrita- 
bihty. He will, so long as he remains poisoned, 



fail to produce at the normal rate. He will tend 
to break down during any period of strain. He 
will tend also to precipitate accidents, because his 
responses to " emergency calls " will be below par. 
Yet he will look " quite well " on most days and he 
will probably declare that he is quite well — and 

believe it. 

The wise employer will therefore perceive that 
these poisoned men and women should if possible 
be eliminated from his working staff— until they 
are cured. He will see that medical examination 
of an employee before he is engaged is a matter of 
great importance, and medical inspection during 
work no less important. The employee, too, will 
find it in his interest to support such examinations, 
because they will afford him protection against over- 
strain and secure him against the insidious onset 
of disease. The State should not be less concerned, 
for it is profoundly true that you cannot conduct 
an A 1 empire, in a business sense, on a C 3 popula- 
tion. Production demands health ; and disease is 
most curable in these early stages of which we have 
been speaking. 

A works doctor, indeed, is a form of insurance 
that must soon become universal. It will be his 
duty to examine all apphcants by the most stringent 
of modem tests. The easily tired, the breathless, 
the sUghtly exhausted, no matter how well they 
look, will be rejected by him after suitable testing. 
These men should then be advised to seek early 
advice— it may be hoped that the Ministry of Health 
will make provision for this— in order that the 


nature of the poison present may be determined. 
If the trouble is teeth, a good dentist will put an 
end to it and the working efficiency of a good man 
be saved ; if it is tonsils, a surgeon will remove 
these ; if it is sluggishness of the alimentary canal, 
a physician may be able to alleviate matters ; if 
it is malaria or dysentery, appropriate treatment 
will restore function to a great extent. Disease 
will have been detected and defeated at the outset 
before its grosser manifestations have had time to 
show themselves. 

The works doctor will also keep all the employees 
under his constant supervision. As soon as a man 
or woman shows a falUng off in efficiency under test, 
a search will be made for the cause of this falUng of!. 
Such questions as alcohol, food, housing will be 
inquired into — faults in all these produce an im- 
mediate effect on the nervous system comparable 
to the effects of disease — and then possible sources 
of poisoning will be looked for — e.g. early tuber- 
culosis of the lungs, bad teeth, tonsils, bowels, in- 
fection by some fundamental disease such as syphihs, 
gonorrhoea, malaria, dysentery, rheumatic fever, 
and so on. The patient will be placed at once under 

It will be seen that in thus serving his own ends 
the employer is also serving the best interests of 
his employee and of the State. It will also be seen 
that quite as much as the workman the master is 
interested in good housing and good health. In 
the absence of these he cannot get his full output 
of labour, no matter what wages he may pay. In- 



deed, there can be little doubt that it would be 
profitable for employers to invest money in schemes 
of public health in the neighbourhood of their 
factories, for by so doing they would cut down the 
incidence of disease among their employees. 

Indeed, there is absolutely no conflict of interests 
as between employers and employed and the general 
body of the pubUc so far as health, hours of work, 
and hours of recreation are concerned. What is 
bad for one is bad for all. Here, then, and not so 
much in elaborate schemes of national health registra- 
tion, Ues the way of preventing and eradicating 
disease. The employer's enthusiasm must infect 
the worker not only because the latter will suffer if 
he does not pay heed, but also because every man 
desires, if the opportunity is afforded him, to 
be and to keep fit. Employer and employee will 
quickly bring their troubles to the notice of the 
authorities in order to secure help. Thus a new 
kind of " detective of disease " will come into 
existence in the shape of the works doctor. The 
works doctor will begin where the school doctor left 



Reports received by the Chief Inspector of Factories 
show, according to Mr. R. E. Graves, that shortening 
of hours has been achieved mainly by means of three 
different systems : 

(1) The one-break day system, under which work 
begins after breakfast and only one meal-time is allowed. 

(2) The two day-shift system, under which work is 
carried on by two shifts of workpeople, each working 
from six to eight hours daily. 

(3) The five-day week system, under which no work 
is done on Saturday. 

In August 1917 the Huddersfield engineering 
employers and operatives agreed to give the one- 
break day system a twelve-months trial. This trial 
was found so satisfactory that in August 1918 it 
was mutually agreed to continue the system. The 
reduction of hours per week was from 54 to 50 
hours — four hours. In Bradford the same system 
was adopted in June 1918. Here the 7.30 a.m. 
starting time was also adopted. As under this rule 

employees could not obtain a good breakfast at home, 




means for making tea half an hour before starting 
time were provided. A firm manufacturing textile 
machinery reduced their hours in 1918 from 53 to 
48, and adopted the after-breakfast starting time of 
7.30 A.M. They furnish the following information 
of the results : 

(1) The moulders on practically all jobs have made 
the same number of boxes per blow. 

(2) Machinists (men and women on piece-work) have 
with one or two exceptions earned the same wages in 
the reduced period. 

(3) Time workers were doing as much as before. 

(4) As regards time-keeping, under the 53-hours 
week 14 to 17 per cent of the men and 17 to 25 per cent 
of the women arrived late. In the same period under 
the 48-hours week only 1 to 1^ per cent of the men and 
1 to 1| per cent of the women arrived late. 

From an engineering works at Bristol, employing 
over 600 hands : 

the manager, noticing that the time-keeping before 
breakfast was very bad, that the men were not fully 
awake, and that the work done then was obviously 
inefficient, called a meeting of the men in 1913 and pro- 
posed to change the hours from 6 to 5.30 (less one and a 
half hours for meals) to 7.30 to 5.30 with one meal hour 
(thus reducing the net weekly hours from 54 to 50), 
with no reduction of wages. A six-months trial was 
agreed to, and the system was found so satisfactory 
that the new hours were confirmed. It was found that 
very little time was lost and that the output had 

No case has been reported of an engineering 


establishment which has once adopted the one-break 
day reverting to the old system. On the other 
hand, a firm of iron-founders in London, who 
reduced their weekly hours from 54 to 52 by adopting 
the period 7.30-6 with one break (instead of 6-5, 
with two breaks), changed back to the old system, 
because " the men objected to the later finish, and 
also because they could not always get breakfast at 
home before starting." The firm state that time- 
keeping was better under the new system, but some 
output was lost. 

In the hosiery and woollen and weaving factories 
in Scotland an after-breakfast start is now almost 
universal. Reports declare that it is becoming 
popular, even those employers who objected to it 
having been won over. For example, the principal 
of a large textile factory says : 

Our opinion is that the new system is excellent, and 
our experience fully justifies its adoption, for it is 
advantageous to both employer and employee. Under 
the old system the average earnings were 22s. 6d., and 
the loss of time 5-5 per cent, while on the new system 
earnings average 25s. Id., and the loss of time only 1-8 
per cent. 

A worker, when asked to explain the fact that 
her earnings had not fallen off in spite of the fact 
that the machinery was running at the same rate, 
declared that this was because *' we have onlv one 
break instead of two ; we never worked as well 
before breakfast as after it, and we are now fresher 
at the end of the day than formerly." 

Data regarding the effect on output are still rather 



scanty, but the general opinion seems to be that 
little alteration has taken place. A firm of spinners 
and weavers in Wales reduced their hours in the 
weaving sheds in 1913 from 52i per week to 49|. 
This was found satisfactory, and the system was 
extended to the spinning department with the 
promise that if output was maintained, no reduction 
of wage would take place. 

Employers in Belfast have formulated their 
views on the shortening of hours, and these may be 
set forth in this way : 

(1) They will be able to draw from a better class of 

(2) It is bad for the workers to have to come out 
before breakfast, especially in winter, and the children 
of the married women suffer considerably under the long 
hours as they have to be taken in " to nurse " before the 
mothers go to the mill in the morning. 

(3) Shorter hours increase the efficiency of the 

(4) Shorter hours improve time-keeping. 

On the other hand, it is feared that there may 
be — and this applies especially to the spinning 
industry — decrease in output and increase in the 
cost of production. If cost of production rise 
beyond a certain limit, linen, being more or less an 
article of luxury, will be replaced by a substitute of 
some sort. Moreover, foreign competition may be 
serious if no safeguards are secured. 

We have already shown that so far as munition 
factories were concerned output did not fall when 
somewhat shorter hours were worked ; on the con- 


trary, the absence of fatigue made the hours of work 
under the new system more productive, and the loss 
of time was made good. This experience is not con- 
fined to munition workers. At a large soap factory 
the weekly hours were reduced from 53 to 48 1, and 
again, two years ago, to 44. The experiment was 
successful. It was found that by speeding up the 
machines even macliine workers could get the same 
output and earn the same wage as before with less 


Again, at a cotton thread works in Yorkshire, 
where the system of shorter hours has been in 
operation for seven years, the weekly hours have 
been reduced from 55| to 49 J. Entire satisfaction 
to employers and employed has resulted. The 
majority of the operatives are on piece-work, and 
the piece-rates have not been changed. The output 
fell at first in proportion to the reduction in hours, 
but "it gradually rose during the following four 
years till it reached the old maximum, which has 
been maintained ever since. The cost of production 
remains about the same as before, time-keeping has 
improved, and absence from sickness has been 

There are some objections to the new system, 
however. In the first place, breakfast before start- 
ing for work leads to an increased consumption of 
coal and gas in the home. The interval between 
breakfast and dinner is regarded by some workers 
as too long (even where work begins at 8 a.m., the 
worker must have breakfast as early as 7 a.m. and 
often much earUer, and this meal is not Ukely to be 



very satisfactory). The remedy suggested is that 
a short break should be allowed during the morning 
spell or fight refreshment should be sent round in a 
wagon, as is done in some cases. Further, it is said 
that confusion is apt to be caused in the worker's 
home when some members of the family work under 
the old and others under the new system. The 
worker's wife must rise very early to cook his break- 
fast instead of merely preparing this overnight. 
Under the old system any hot drink or food was 
prepared by the worker himself. 

Against these objections, which are urged by the 
workpeople themselves, may be set the fact that 
under the new system workrooms are more comfort- 
able, particularly in winter, when they can be 
properly warmed before work begins, and the 
employees get more sleep. Moreover, people go to 
bed later nowadays and thus feel the effects of an 
early start more. 

The two-day shift system involves work in shifts 
between, usually, 6 a.m. and 10 p.m. It is thus not 
permissible for women and young persons under the 
provisions of the Factory Act. Inspectors report 
that where it has been employed few objections have 
been raised against it. Indeed, many workers ex- 
press themselves as well pleased. Nor have adminis- 
trative difficulties been encountered. As a rule 
Shift I. works Monday to Friday 6 a.m. to 1.30 p.m. 
or 2 P.M., and Saturdays 6 a.m. to noon, with half an 
hour for breakfast. Shift II. works Monday to 
Friday 1.30 or 2 p.m. tiU 10 p.m., with haH an hour 
for a meal about 5 p.m. and no work on Saturday. 


In a chocolate factory working 6 a.m. to 1 p.m. and 
1 P.M. to 8 P.M. the scheme is said to be very satis- 
factory to both employers and employed ; the out- 
put is at least 50 per cent greater than under the 
old hours (9 a.m. to 7 p.m.). Some workers declared 
that they much preferred the two-shift system and 
were in better health on account of it. The system 
also puts an end to overtime, which has been shown 
by experiment to be a costly and unproductive 
method of work. The volume of available employ- 
ment is incidentally increased. In several cases, it 
is stated, the adoption of the system has enabled a 
firm on ceasing war contracts to avoid discharging 
numbers of its workers, to absorb demobihzed men, 
or to take on women discharged from neighbouring 
munition works. The system also affords a means 
of increasing total national production and of de- 
creasing the cost of production. 

Finally, there is the five-day week system. It is 
not, so far, on a very satisfactory footing. At one 
large textile factory where it was adopted on trial 
for some time the output fell off so much that the 
firm changed to a six-day week with an after- 
breakfast start at 8 a.m. and one meal hour. The 
result of this second change was that, notwithstand- 
ing shorter weekly hours, the output increased again. 
It becomes clear therefore that under either the 
one-break day system or the two-shift system shorter 
hours can be afforded without much immediate risk 
to the employer in respect of output and with very 
distinct advantage to him in respect of health, good 
time-keeping, and general well-being of his workers. 



The workers, too, when adjustments have been 
made for certain details of the scheme, stand to gain, 
for they obtain more leisure and do not suffer loss 
of wage. They become healthier and thus better 
members of the community. The community as a 
whole benefits in the benefit of each of its members 
and does not seem to lose in respect of greater cost 
of production. 

The results of the shortening of hours below the 
figures we have quoted remain to be seen. It will 
be information of intense practical and physiological 
interest, for it is quite clear that the optimum 
working time for industry in general has not yet 
been determined with a sufficient degree of accuracy. 





Upon the health of the nation trade and commerce 
rest as upon the only sure foundation. For this 
reason the report On the Physical Examination of 
Men of Military Age by National Service Medical 
Boards is a document of vital interest to the trading 
and manufacturing community. 

A word of caution is, however, necessary in 
studying the figures. They refer to examinations 
carried out from November 1917 to October 1918 — 
that is to say, to examinations during a period when 
it might be assumed that the best men in the country 
had largely been recruited, and that what was left 
over was indifferent material for the most part — 
though no doubt some good men in a physical sense 
were " released " to swell the ranks at this time. 

This view has indeed been advanced to discredit 
the figures presented. It is not entirely trust- 
worthy. The report states that as the figures 
include a very large number of men in protected 
industries, which in the nature of things employed 
fit workers, men previously rejected when the need 


for them was less urgent, men now refused exemp- 
tion by the tribunals, lads attaining the age of 18, 
and a small number of men between 41 and 51, 
they may be taken as fairly representative of '' the 
manhood of mihtary age of the country in the early 
part of the twentieth century from the standpoint 
of health and physique." 

Of the 2,425,184 men examined 871,769 were 
placed in Grade I., 546,276 in Grade II., 756,859 in 
Grade III., and 250,280 in Grade IV. This may be 
expressed as follows : 

Grade I. . 

. . 36 per cent 

„ II. . 

. . 22-23 „ 

„ III. . 

. . 31-32 „ 

„ IV. . 

. . 10 

Thus, only one in every three had attained the 
full normal standard of health and strength, and 
was judged capable of enduring physical exertion 
suitable to his age. Again, about one in every five 
went into Grade II. as capable only of undergoing 
such physical exertion as does not involve severe 
strain. One in every three presented marked 
physical disability (Grade III.) — the so-called " C 3 '* 
population. Finally, one in ten were judged to be 
*' totally and permanently unfit for any form of 
mihtary service." 

The standards applied were necessarily of great 
importance. So also was the method of measuring 
the fitness of any given group of men. In its simplest 
form the idea was that each Grade I. man should 
count 1, each Grade II. man f, each Grade III. man 
J, and each Grade IV. man J. Thus, if a batch 




of men had 893-75 units of fitness, on the above 
method of calculation it might be said to have an 
" Index of Fitness " of 89-37 per cent. 

This index of fitness was determined in an attempt 
to discover the relations of occupation and health — 
the first attempt of this kind ever made in England. 
The following table shows some of the results 
obtained : 


Standard (Professor Keith) 



Agriculturists (another group) . 


Iron and Steel Workers 

Lace Workers 

Woollen Trade * 

Woollen Trade (another group) 

Index of 


In the western valleys and eastern portions of 
Carmarthen the percentage of Grade I. miners was 
higher than in any other part of Wales. The miners 
here are usually the sons of farmers. The man is 
born and bred on the land, in healthy surroundings, 
very different from the conditions obtaining in the 
case of most industrial populations. The coal 
seams, too, are high, and there is little dust. Hous- 
ing conditions are good. Miners generally, indeed, 
furnish good recruiting material, being generally well 
fed and well developed — facts which speak well for 
their sporting instincts, love of exercise, good feed- 
ing, and high rate of intelligence. 





The physique of the metal worker, on the other 
hand, is poor — " doubtless because he works in a 
superheated atmosphere, and has to stand for long 
hours upon hot surfaces." The evil effects of certain 
types of work — which effects can often be, and ought 
to be, prevented — is shown by the following table : 

Index of Fitness 

Combined average gradings of Boards examining 
mainly Colliers in N.W. region . . . 

Combined average gradings of all men examined in 
Great Britain in April 1918 . . . . 

Oracling of 290 Cotton -operatives examined ^- 
Stockport Board, on April 5, 6, 8, and 9, 1918 

The comment made is : "A remarkable and 
arresting illustration of the effect of our industrial 
sj^stem upon the health and physique of one class of 

The causes of rejection are of great interest- 
The following table speaks for itself : 

200 Youths of 18, 19, and 20 rejected 

Poor physique 
Physical defects 
Tubercle of lung 
Tubercle of other organs 
Heart disease 
Eye diseases . 
Deaf and dumb 
Epilepsy . . 

Perhaps the most extraordinary table illustrating 
the causes of rejection is that given for the London 
region. In this region 160,545 men were examined 
during the period January-October 1918. Of these 
no fewer than 15,947 were rejected for heart diseases 
— very many of which are due to infections incurred 


Mentally deficient 



Skin diseases . 






Goitre . . . . 



Graves' disease 






Otitis media . 



Other diseases 




since childhood. Consumption claimed 4327, other 
tuberculosis 911, and syphihs 656. No fewer than 
48-5 per cent were unfit for Grade I. 

The report illustrates also the fact that the youth 
coming to the army in the latter days of the war 
was far from being as fit as might have been ex- 
pected or hoped. During the period under review 
261,137 boys bom in 1900 — i.e. about two-thirds 
of all the boys who became 18 in 1918 — were 
examined and graded with the following results : 

1. A deficit according to standard expectations of 
nearly 13,000 Grade I. youths. 

2. An excess of over 6000 Grade IV. youths, or, in 
other words, almost double the number of youths unfit 
for service — " totally and permanently " which there 
should have been, judged by Keith's Standard. 

3. A total deficit of more than 11,000 units of fitness 
(4*3 per cent). 

The following table should also be studied : 

834 Youths of 18 examined by a Liverpool 


Grade I. 

Grade II. 

Grade III. 

Deferred and 







Average height . 
weight . 
chest girth 



5 ft. 6 in. 
114 1b. 
30.7 in. 

In the light of this and other returns it is inferred 
that a combination of height, 5 ft. 5 in., weight 
116 lbs., and chest girth 32 ins., represents the 



average standard which the youths of the North 
Western and West Midland regions attain at 18 
years of age. The comment is made : " We cannot 
doubt that these proportions would be greatly 
improved by better conditions of life and environ- 
ment during childhood, boyhood, and especially (as 
the results of army training have demonstrated) by 
better food, and better opportunities for physical 

This is the moral of the figures for the statesmen, 
educational authorities, doctors, and men of com- 
merce who may take the pains to study them — that 
all this waste of strength, and so waste of working 
power, is capable of being prevented. It represents 
dead loss. It has to be paid for twice over, first, as 
a burden on the community, and, secondly, as a 
loss of energy which might, had other methods been 
employed, have been available for the benefit of the 
trade of the country. 

There is, indeed, no proper division of health 
care into " care at school," " care in the factory," 
" care at home," and so on. The nation's health is 
truly " one and indivisible." It is a chain every 
link of which is vital. By that chain hangs the 
nation's strength, its trade, its industries, its future. 

The following graphs are taken from the report : 





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We propose now to view the subject from a 
somewhat different angle, and examine the returns 
of physical efficiency in its relation to specific trades 
for the London area. 

We may take first of all those trades classed as 
" indoor sedentary ''—e.g. clerks, piece-workers in 
the cloth trade, tailors, bootmakers, printers, com- 
positors. These occupations produced some 25 
per cent of Grade I. men, some 23 per cent of Grade 

II. men, some 39 per cent of Grade HI. men, and 
12 per cent of Grade IV. men. 

When we come to analyse the nature of the 
diseases which afflicted these 51 per cent Grades 

III. and IV. men we find that pulmonary tuber- 
culosis accounted for by far the greater number 
of Grade IV., and valvular disease of the heart for 
by far the greater number of Grade III. men. In- 
door sedentary workers may no doubt in many 
instances choose their occupations because they 
have lung or heart disease, and it would not, there- 
fore, be fair to ascribe to the occupation the cause 
of the malady. On the other hand, the idea that 
many victims of pulmonary tuberculosis— " con- 
sumption " — are employed indoors is a very dis- 
quieting one. It can only mean that many healthy 
persons are infected by them, and that consequently 
the danger of consumption to workers in the cloth 
trade, tailoring trade, printing trade, and so on is 
greater than it need be. 

If we compare these indoor sedentary with in- 
door active trades— hotel porters and servants, 
indoor servants, excluding waiters and chefs, shop- 


keepers and shopkeepers' assistants (other than 
those concerned with food supply), teachers, legal 
profession, dental profession, chemists, etc.— we find 
that while the percentages of Grade II. and III. 
men are almost identical, the diseases cliiefly causing 
these percentages are rather different. 

Consumption is still responsible for a large number 
of Grade IV. men, but equally bad in this respect 


3 4 / ^ 3 4 



37,210 30.470 

12 3 4- / _ „ _ 

Concerned wit^ & c 




Fig. 6. 


'deformity," including flat feet, hammer toe, 
and spinal curvatures. These deformities also 
account for many Grade III. men. Occupations 
such as shop assistantships demand constant use of 
the feet and prolonged standing about. It is mani- 
fest that no man (or woman) who shows signs of 
weakness in muscles or joints should be permitted 
to enter these callings except under medical super- 
vision. Heart diseases are also prevalent in this group. 



Coming to the case of the tradesmen — e.g. shop- 
keepers and assistants handHng food, milkmen, 
waiters, chefs, and so on— we find a marked increase 
in Grade III. men and a slight increase in Grade IV. 
The marked increase can be traced to the following : 
(1) Deformities ; (2) diseases of the lungs other than 
consumption, which is, however, sufficiently pre- 
valent ; (3) diseases of the heart, and diseases of the 
yeins — e.g. varicose veins. Even worse than the case 


Craftl P 3 4 12 3^ 1234 1234- 


mXrDWORKERS !a967 15,013 2;304 

Fig. 7. 

12 34. 



of those handlers of food — which is bad — is that of 
the barbers and manicurists, which is the worst of 
all. This group has the highest Grade IV. per- 
centage of any — more than double that of the 
'' skilled workers." The disease mainly responsible 
is consumption, and it is an uneasy reflection. 

In remarkable contrast to the state of matters 
in these trades is the position with regard to the 
skilled workers — e.g. munition workers, shipbuilders, 
plumbers, gasfitters, carpenters, engineers, painters, 



blacksmiths, etc. Here we have a very high per- 
centage of Grade I. men and a very low percentage 
of Grade IV. men. Consumption is much less 
prevalent, but heart diseases seem to be relatively 

*' Labour," including unskilled labourers, 
scavengers, dockers, etc., shows a less advantageous 

Grade 4. .■■ 

Grsde 3..C3 






DEFORMITitb vConaer.iUil 



Fig. 8. 


return than that of the skilled workers, and a similar 
state of affairs exists for the transj^ort workers — 
e.g. outdoor porters, messengers, cabmen, taxi- 
drivers, omnibus and tram drivers and conductors, 
carters, draymen, postmen, railway porters, and 

This analysis makes it clear that the three diseases 
which are most destructive to industrial efficiency 
are " deformity," " consumption," and " heart 



disease." The first may not, it is true, hinder a 
man or woman from performing a sedentary occupa- 
tion. But this is a narrow view of the subject. In 
no occupation is a deformity an advantage either 
to master or man. It Hmits movement, it inflicts 
pain and weariness, it exhausts strength, and induces 


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Fig. 9. 

fatigue. It is thus a true enemy of industry, of out- 
put, of progress. Consumption and heart disease 
are, of course, enemies of the most immediate 
and deadly character. 

The tremendous economic importance of these 
groups of diseases is evident when we compare in 
a graphic manner the records of digestive disease 




or nervous diseases with the records of deformity, 
consumption, and heart disease. 

If now we look at these diseases in relation to 
age we find that at all ages they remain dominant. 

These figures refer only to the London area, but 
they are more or less representative. They teach 
the plain truth that if we could cure deformity in 
childhood, when it usually begins, prevent consump- 

Grade 4 IB 
Grade 3 O 

:^ $ $ 

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Fia. 10. 

7 - 1 




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tion, and handle the problem of heart disease — a 
far bigger and more compUcated subject than the 
public has yet begun to reahze — we should add im- 
mediately and enormously to the working power of 
the nation as a whole, and so to the efficiency of 
all our industries. 

The immediate lesson of this very exhaustive 
and very fascinating inquiry is that the problem of 
industrial health is always twofold. There is the 
question of suiting the worker to his work, and there 





is the question of preventing his work from making 
a fit man unfit. The deformed worker is unhappily 
— as a result of the war — all too common a sight 
in our shops to-day. We must, in our own and in 
his interest, see to it that his labours do not ex- 
aggerate his deformity and so lower his productive- 
ness. The consumptive worker we must look for, 
find, and exclude before he has infected others. 

In what way, then, can employers of labour 
hope to rid themselves of this great incubus of 
disease ? Are there any steps which can be taken 
at once ? We may well turn to examine the problem 
in the light of modem progress. 

The question of deformity, as we have indicated 
in former articles, is certainly the most urgent of 
all, because the war has left a terrible legacy in this 
respect. Deformity is largely preventable. With 
this aspect of the matter we shall deal in a moment. 
But even deformity which has become estabhshed 
is a relative rather than an absolute disaster. If 
the man is set to work to a task which demands 
two hands and he possesses but one he is an inferior 
craftsman. But if a method of work be devised in 
which one hand may serve for two his capacity may 
not be lowered after all. 

This fitting of the worker to his work is now a 
branch of Avhat is called orthopsedic surgery. In its 
ruder manifestations that art has long been practised. 
But war surgery has evolved many new methods. 
Thanks to the skill and care spent on this branch 
it is now possible to render all but the most hopeless 
cases fit for a large measure of activity. 


The medical man can help here in a very real 
way. At the present moment Great Britain can 
boast of the most distinguished school of orthopaedic 
surgery in the world. At the head of this school 
stands Sir Robert Jones, its founder, to whose work 
and inspiration it owes indeed its very existence. 
If those manufacturers who have signed the King's 
Roll of Honour would invite Sir Robert Jones to 
nominate one of his pupils as their adviser, there 
can be but Uttle doubt that they would quickly 
profit by this measure. Lines of action would be 
suggested to them which would increase the pro- 
ductiveness of their disabled workers. The subject 
has been fully studied at a large number of centres, 
and special trades have been brought under observa- 
tion. It is a great pity that the manufacturers of 
the country should not reap the benefit of this 
special knowledge. 

But if it is to the immediate interest of trade 
that every disabled man should be able to do work 
to the fullest of his power, it is equally to its interest 
that deformity and disablement should be stamped 
out altogether. Some time ago Sir Robert Jones 
outlined a great scheme which has in view the cure 
of crippled children throughout the length and 
breadth of the land. Disablement is curable in 
early years, he pointed out, and the good can be 
achieved with small difficulty if a proper organiza- 
tion exists. He proposed to take over the ortho- 
paedic hospitals one by one from the Ministry of 
Pensions and turn them into centres where deformed 
children could be reformed. 



To some employers this may seem a project far 
separated from industrial hygiene. But a little 
consideration will show that this is not the case. 
The deformities of to-day must make the inefficient 
workers of to-morrow unless the weaknesses which 
cripple are dealt with and cured. This is Sir Robert 
Jones's case. If the employers of the country would 
rally to his side, his great project would certainly 
be reaUzed. In ten years the huge volume of de- 
formity would be reduced to reasonable proportions. 
The case of consumption is rather different, but 
here Ukewise we discover the possibiHty of im- 
mediate action and also of more remote measures 
of prevention. We have shown that consumption 
was one of the great causes of rejection for the army. 
We have also shown that this disease was found to 
be prevalent in almost all industries. It is quite 
clear, then, that industrial life is a potent factor 
in the dissemination of the disease. 

This idea cannot but reveal to the whole body 
of industry the danger which it is so lightly courting. 
In a vast number of workrooms and factories the 
deadly tubercle bacillus is being blown about and 
inhaled by men and women so far healthy. Th? 
unsuspected case, closely associated with his fellows 
in hot atmospheres and crowded spaces, is deaUng 
out sickness and death, converting an A 1 popula- 
tion into a population fit only for 3. In a larger 
sense he is impeding the human machinery of in- 
dustry, breaking it down, and so causing great loss 
to those whose welfare depends on the efficiency 
of the machine. 




It is really amazing that at present so little care 
is expended to prevent persons infected with tuber- 
culosis from being engaged for work in areas in which 
they cannot but prove a menace to every one 
associated with them. One might have supposed 
that every employer would perceive how badly he 
studied his own interest in allowing his workpeople 
to run this great risk. The State, too, has the 
clearest possible interest in preventing what is 
nothing other than an invitation to calamity. 

There is only one remedy — medical examination 
before engagement. This should be instituted by 
every employer. The small cost will quickly be 
made good in increased health and well-being. If 
the employers fail, the workpeople in their own 
interest are certain to take active measures very 
soon ; for medical knowledge is spreading among 
the people and medical dangers are becoming more 
keenly appreciated. The table on following page, 
extracted from a report from the West Midlands 
district, illustrates the enormous influence of industrial 
occupation on the incidence of consumption, and 
shows also that those who lead an outdoor Ufe reap 
a great benefit. 

It will be seen that clerks and engineers were 
the worst sufferers. The clerk from his mode of 
work is in a position the most favourable for dis- 
seminating the disease. 





• • 









• • 









■ • 


• • 

• • 


• • 



• • 


• ■ 

• • 




fl • 


■ • 



• • 



a • 







• • 

• • 


• • 



• • 


• • 











• ■ 

• • 


• a 




• • 

• • 


a a 

a a 
• a 








a a 




• a 


• ■ 


















• a 

• a 







a a 










Boat builders . 
Boatmen . 
Brass workers . 
Butchers . 
Engineers . 
Factory workers 
Farmers . 
^Farm labourers 


It by no means foUows, however, that because a 
man is affected with tuberculosis industry is done 
with him. Were that the case the community must 
support a really huge number of persons capable 
to a greater or less extent of earning their own 
Uvings. What is required is a choice of employment 
and a careful medical supervision. 

The late Sir Robert Morant, whose untimely 
death has robbed this country of one of its greatest 
health authorities, was deeply impressed by the 
need of action by the State in the direction of the 
employment of the consumptive, and after long and 
patient investigation inclined to the view that the 
" viUage colony " system offered the best solution. 
The idea is really a working colony Uving in condi- 
tions favourable to the affected person and carrying 



on forms of employment which are suitable to the 
physical state presented. 

Most employers, and especially those who take a 
personal interest in their workpeople, have learned 
to their cost that when a man is sent away for 
sanatorium treatment and returns later " cured," 
the period before a further breakdown occurs is 
usually short. Sanatorium treatment has con- 
sequently fallen into disrepute. The real cause of 
the failure is seldom understood. It is that the man 
returns from good conditions in which he did well to 
bad conditions — especially bad home conditions — in 
which he does badly. He loses his " sporting chance," 
so to speak, and relapses into chronic ill-health. 
Moreover, he begins to infect his fellow- workers. 

The colony system is designed to prevent this. 
It is recognized that once a man in general employ- 
ment shows signs of tuberculosis he should make 
up liis mind to change his mode of work. His 
employer should understand that the best thing for 
all concerned is that this man should not — at least 
for a long period— return to office or workroom. 
He should go, in the first instance, to a sanatorium 
and then to a village colony, where in course of time 
he may become once again a useful member of 
society, where he will be under constant medical 
supervision, and where he will not, in any case, 
infect healthy persons with his disease. 

The success of the village colony scheme depends 
to a great extent on the support which it receives 
from the great — and small — employers of labour. 
If they adopt an enUghtened attitude the scheme 



will be established and industry relieved of a great 
danger and burden. If, on the contrary, they 
refuse their support no progress can be made. Let 
them recall the terrible fact that 50,000 persons, 
mostly employed in industry, die of tuberculosis 
every year, and further, that there are some 90,000 
fresh notifications of tuberculosis every year. The 
\illage colony at Pap worth, in Cambridgeshire, is a 
model of what ought to be and can be done. A 
visit to that place would open the eyes of many a 
business man to the vast importance of the cause 
which we are now pleading. 

The third and last of the great disabUng diseases 
is heart disease. We are here considering what has 
become one of the most difficult problems of modem 
medicine, for, thanks to the work of Sir James 
Mackenzie, it is becoming increasingly clear that 
heart disease is seldom a separate entity, but most 
commonly owes its origin to some infection which 
has become established in the system. This view 
is not so revolutionary as it may appear at a first 
glance, because it has been known for years that 
rheumatic fever was a fruitful cause of heart mis- 
chief, and the same can be said of syphilis. But 
the modern idea is much wider and more com- 
prehensive than that of older workers in this field. 
It embraces indeed a host of small troubles curable 
in childhood, incurable in later Ufe. 

The first point to be grasped by every employer 
is that heart disease very seldom arises by itself — 
it occurs as a second stage of some other condition. 
This other condition is frequently curable. Conse- 


quently, if an employer has the benefit of medical 
advice he can — by attention to the small complaints 
of his workpeople — ward off the greater complaints. 

Let us take a few illustrations. It has been shown 
that heart conditions are apt to follow infectious 
fevers Uke influenza and pneumonia. They occur 
very often in men afflicted with tuberculosis and 
sypliiHs and rheumatic fever. They are common 
after ear trouble, throat trouble, abscesses, and 
derangements of the digestive organs— notably con- 
stipation. AU these ailments can be dealt with if 
workpeople are under regular medical supervision. 
To deal with them is to restrict and check their 
serious consequences and so protect industry from 
one of its worst enemies. 

The truth is that heart disease, in a broad way, 
represents the results of untreated and unchecked 
infection. It thus represents the failure of industrial 
hygiene. Where it is prevalent the shghtly unfit 
are being turned into the very unfit ; the skilled 
worker is being damaged so that his skill is lost to 
his employer. For the same poison which affects 
the working of the heart affects also the working of 
all the other organs. It affects the nervous system 
and produces a state of fatigue and irritability. 
The man cannot give of his best. He " drags " 
through his work for years before the final break- 
down occurs. He is a bad investment. 

So accustomed has the public become to regard 
heart disease as a manifestation of the action of fate 
that this view is very difficult to assimilate. It is 
easy to persuade people that consumption is an 



infectious disease which can, and should, be con- 
troUed. They know of the baciUus of tuberculosis 
and can understand how this bacillus may be carried 
from one worker to another. But they have great 
difficulty in seeing how the infections which originate 
heart disease can be so transmitted. They do not, 
indeed, recognize that infections do originate heart 

And yet the evidence on this point is becoming 
almost overwhelming. No one seriously disputes 
that rheumatic fever is apt to be foUowed by a 
heart infection. Recent work — work which is at 
present being carried on — strongly supports the idea 
that rheumatic fever is due to a bacillus and that 
this germ fives in the throat and can be transmitted 
from one host to another. Again, no sort of doubt 
exists that syphilis is a frequent cause of heart 
trouble. Yet so far the employers of the country 
have taken no part, or only a very small part, in 
the campaign to prevent the spread of venereal 

Again, bad teeth, with dental abscesses at their 
roots, are a common source of poisoning and of ill- 
health. Here is a fruitful source of heart mischief, 
as any dentist will testify. When the heart becomes 
affected the worker is lost and it is too .late to do 
anything. But had the teeth been looked to in the 
first instance the disease would have been prevented. 
Bad teeth, again, lead to bad throats, which are 
infectious. Thus one foul mouth in a factory or 
workshop may become a focus of disease and may be 
the means of robbing a firm of invaluable employees. 



It becomes evident, then, that immediate action 
against heart disease, as against consumption, con- 
sists in adequate medical examination, not only at 
entrance to the works but also at intervals. Happily 
many firms have reaUzed this. Those firms which 
lag behind will receive some help from the new 
Education Act, which aims at sending every school- 
boy out into the world of industry with a health- 
record carried on from his infancy. 

The time has certainly arrived when employers 
should estabhsh close relations with the juvenile 
employment boards, which again are in close rela- 
tions with the schools. In this way industry will be 
able to protect itself against the unfit and will at the 
same time begin to exercise pressure on the school 
medical service to prevent unfitness. The heads of 
the business world do not as yet realize how im- 
mediate would be the response to a demand made 
by them for fit youths to fill the ranks of their 
workers, and how, were they able to emphasize the 
present low grade of industrial health by reference 
to medical statistics collected in their own factories, 
this complaint would stimulate the efforts of the 
health authorities. Disease flourishes in this and 
other lands because it has not yet come to be looked 
upon as a crime. When industry begins to demand 
health industry will assuredly get it. All our 
administrators know that if only commerce could 
be enhghtened on this point the battle against sick- 
ness would be as good as won. 

Progressive firms now employ doctors. These 
doctors report fully on the state of candidates for 



employment. Thus the consumptive is prevented 
from entering shop or workroom. The victim of 
bad teeth is refused work until such time as his 
teeth have been put right, or until he has visited the 
works' dentist. Thus a potential cause of heart 
disease and a potential enemy of industrial efficiency 
is either got rid of or turned into a sound and useful 

Grade 4....\ 
Grade 3....\ 


A) — 
to "^ 

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3 rH ■ ! i I I i i rH <^^' 

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Fia. 11. 

Comparison between valvular disease and digestive disease 

in an English area. 

worker, a man, in the phrase of a well-known 
business man, "worth teaching his job." Again, 
the possessor of a foul or relaxed throat is ordered 
to have treatment for the same, and so prevented 
from setting up an epidemic of tonsiUitis in the 
establishment, which epidemic might conceivably 
rob the employers of their most valued servants. 

The victim of venereal disease is ehminated or 
handed over for cure. Another grave danger is thus 


averted. The worker whose digestion has been 
ruined by improper feeding is given a chance to 
regain his strength or advised against a type of 
employment which could only result in further 
damage. The sufferer from skin disease is prevented 
from becoming a menace to all his fellows. Not 
only so, but a regular system of inspection ehminates 
small diseases which, soon enough, would develop 
into serious maladies. 

This poUcy, then — the employment by every 
industry of medical inspectors and referees — would 
do more to prevent the spread of disease than 
almost any conceivable measure, except, perhaps, 
the school medical service. It would strike at the 
roots of what are called the " killing diseases "— 
especially heart diseases. The result would be a 
safer middle age and so a more productive middle 
age. Every employer knows that the workers of 
greatest value to him are those who possess the 
highest degree of efficiency. They range, as a rule, 
from 30 years of age upwards. That is about 
the age when the " kilhng diseases "—the plants 
raised from the seeds of trifling afflictions— begin 
to manifest themselves. These " right-hand men " 
are thus too often lost for want of a Uttle care. 

No employer would dream of leaving trifling 
ailments in his machinery untended. Our business 
world has many maxims, but none more often re- 
peated than " A stitch in time saves nine." Yet a 
highly-trained worker is always of more value than 
a machine. He is worth taking care of. 



There is no subject which is of more vital interest 
to the employer of labour than that of " lost time." 
So far as the somewhat scanty investigations which 
have been carried out on the subject go it would 
appear that the evil is very great and. widespread, 
and that" its more obvious manifestations by no 
means exhaust the extent of its effects. There is 
lost time which can be reckoned in hours or even 
days. There is also lost time which is of the fabric 
of the day's work, so to speak, and which cannot be 
reckoned except by reference to the figures of output. 

This latter is, perhaps, the more serious form, for 
it springs from causes which, in other directions, are 
working against the efficiency of the factory as a 
whole. They are physical causes and also mental 
causes. Most of them are remediable. On the 
other hand, employers seem to be slow to realize 
that a bad " atmosphere," in the psychical sense, is 
as dangerous to their pockets and general well-being 
as a slump in trade or a break-down of supply. 

Some time ago the subject of lost time was 



examined by a Government committee, who re- 
ported upon it at considerable length. They divided 
the conditions covered by the term as follows : 

First, gross loss, actual absence from work for 
whole days or weeks, a degree of broken time which 
greatly interferes with the management of a factory. 
Second, what is known as " loss of quarters," 
and particularly the "morning quarter" — Professor 
Loveday found in a prolonged investigation that the 
percentage of lost time before breakfast varied from 
20 to 58 in a group of 17,000 persons working a 
normal day beginning at 6 a.m. or between 6 and 
7 A.M. This loss was greatly in excess of any 
similar loss in factories which started work later 
than 6 a.m. It is added : " The magnitude of this 
common experience, the actual number of absences, 
the futihty of working before having had a morning 
meal, and the waste of time incurred in two breaks 
daily have led many employers to the view that the 
two-break system might well be abolished." 

Third, time lost in starting work even by a good 
time-keeper, and similarly time lost in ending work. 
In this connexion a statement of great interest was 
made by Dr. Vernon, in which he pointed out that 
when the motive power of the factory is electric the 
time occupied in starting work can be estimated 
from the circumstances that as the operatives got 
going, one after another, the power consumption 
steadily rises to a maximum, which is attained when 
all have begun. Allowances have to be made, of 
course, in cases where necessary tools must be 
collected before work. In one instance where men 



were compared with women it was found that the 
latter wasted about seven minutes more in starting 
than did the former. On the other hand, the 
women finished more quickly than the men. It was 
found that both sets of operatives lost, on an average, 
about the same aggregate of time in starting and 
finishing during the course of the day — viz. thirty- 
four minutes. In another case the effect of the 
approach of the Easter holidays on a group of women 
workers was to prolong considerably the time taken 
to start work. For a few days after the holidays 
this effect persisted in an aggravated form. The 
comment is made : " There can be no necessity 
for the waste even of 25 minutes in starting 
and finishing work. Ten or 15 minutes should 
be ample allowance, and the 20 minutes thereby 
saved could be deducted from working hours with- 
out any reduction of output." 

Fourth, loss due to unregulated rest pauses, 
absence of pauses, to long spells, and other faults 
in factory organization. It is contended that the 
custom for operatives to work five hours and then 
after an hour's meal interval go on working another 
spell of four and a half hours is a bad one. These 
spells are too long, and a rearrangement seems to be 
called for. 

The causes of these various types of loss are very 
numerous, as will be readily understood, and it is 
difficult to disentangle them in some instances. One 
of them is certainly the presence in the ranks of 
labour of unfit men, whose maladies have not been 
recognized and so go untreated. These men are 




often physically incapable of keeping good time, 
and their apparent bad example infects others, and 
lowers the whole tone of the factory. Again, the 
conditions in which the workers live is a matter of 
great importance. Dirty and inconvenient houses 
play a great part in wearing down that fitness of 
mind and body out of which alone good work pro- 
ceeds. This matter is engaging general attention at 
present. In 1911 the Medical Officer of Health for 
the County of London stated that there were 
" throughout London about 1900 groups of three or 
more houses which were either insanitary or so con- 
gested, badly arranged, or badly situated that they 
required to be dealt with. The number of dwellings 
in these groups was 25,734, occupied, it was esti- 
mated, by about 195,000 persons." 

On the other hand, an even more fruitful source 
of lost time is the difficulty of transport to and from 
work. This greatly comphcates the housing ques- 
tion, because if the bad old houses surrounding the 
factories are to be got rid of the population will 
require to come to work over considerable distances. 
The workers themselves are very reluctant to go 
far afield because this means an earUer start in the 
morning and a later return at night ; moreover, 
travelling is expensive. Local authorities, too, are 
reluctant to displace residents in their districts 
unless it be possible to re-house them in the neigh- 

It is clear that there is here a dilemma which will 
be difficult to solve. The employer, however, will 
assuredly serve his own best interest if he makes war 



upon the dirty house. Employees who come to him 
fresh and cheerful in the morning, provided they 
havfe not too far to come, will spare his time and 
afford him a service which the tired, the dirty, and 
the dispirited cannot render. Another fruitful cause 
of lost time is industrial fatigue. With this we have 
already dealt. 

Reviewing all these causes, the expert committee 
were satisfied that " the loss of time directly and 
indirectly due to fatigue and ill-health is substantial, 
and is as a rule greatly under-estimated." On the 
other hand, " there would seem to be a tendency to 
over-estimate that due to slackness, laziness, or wilful 

The cure for loss of time cannot, therefore, be of 
the nature of a nostrum. It must be as manifold as 
the phases of our complex social system. Shorter 
hours, for example, will help ; so will improved con- 
ditions and circumstances of labour, including a high 
standard of efficiency ; so will better housing and 
more rapid transport ; so will good health. 

These things can only arrive slowly. Meanwhile 
employers would be well advised to find out, each 
man for liimseK, just how much time is being lost 
in the business or factory they preside over. Careful 
records should be kept of 

(a) Lost and broken time. 

(b) Absence or broken time due to sickness. 

(c) Output per worker per hour so far as this can 
be ascertained. 

Lost time, after all, is one of the diseases of in- 
dustrial life. Unless the disease is diagnosed in any 


particular business no steps can be taken to cure it. 
When its presence has been recognized the employer 
will be in a position to look for immediate causes 
and to think out special remedies suitable to his 
own case. 

This brings us to the obverse of the problem — the 
kind of incentives to work which the employer may 
place before his workpeople. The committee we 
have referred to placed the health of the worker 
before all other considerations, even as an incentive 
to good output, and this finding was based upon very 
careful and searching tests and experiments. They 
urge the employer to realize that everything he can 
do to increase the well-being and comfort of his men 
and women mil in the end prove a source of j)rofit 
to himself. 

Thus, they urge the necessity of good lighting on 
scientific principles, effective ventilation, sufficient 
heating, cleanliness, rest rooms, proper canteen 
accommodation, and measures of protection against 
accidents and industrial diseases. Thev would 
further extend the care to the homes of the work- 
people in so far as this can be done. 

Only second to the health of the workpeople they 
place as an incentive to output a properly organized 
factory in which the rate of machinery and other 
matters have been carefully considered and in which 
good order and discipline are enjoined. The hours 
of work must be such as to avoid fatigue. This view 
has been strongly insisted upon by other observers. 
Professor Loveday wrote : " When once industrial 
life has been entered upon the ordered and syste- 



matic routine of a modern factory is a direct 
stimulus during every 24 hours to the rhythm of 
activity and rest ; the better the organization and 
the better the hygienic environment, the greater is 
the stimulus to activity." 

Finally, there is the wage as an incentive to 
effort and to the avoidance of loss of time. It is a 
matter of first importance that whatever method of 
payment may be adopted this method should be 
clearly and thoroughly understood by every em- 
ployee. Employers often fail to realize how simple 
are the ideas of many of those who work under them 
and how violently a sense of injustice reacts upon 
a simple mind. Misunderstanding is the fruitful 
mother of this sense of injustice, and once a wrong 
impression has got abroad it is very difficult to 
eradicate. The effect of it will soon be evident in a 
lack of enthusiasm or even in positive ill-will, and 
these, again, will rapidly translate themselves into 
lost time and diminished output. Every care, there- 
fore, should be exercised to explain the system of 
payment to each employed person. 

As a general rule piece-rates appear to exercise a 
better effect than time wages, and time wages with 
a bonus than a flat time rate. Piece-work, on the 
other hand, has its dangers, for it is apt to lead to 
overwork and so to work which is of inferior type. 
This can only be met by securing that employees 
understand how greatly their own success and 
prosperity depend on the care they take of their 
health. Many far-seeing employers encourage the 
deUvery of health lectures to their workpeople, and 


even go out of their way to arrange for tliese to 
attend them. They are rewarded wlien it becomes 
a fixed principle of the operatives they control that 
a sick man is a danger to his fellows. 

Once again we perceive how real is the community 
of interest between employer and employed, or, if 
you will, between capital and labour, and how false 
and unenlightened the idea that these two are at war 
with one another. Every advance in knowledge, 
every improvement in scientific technique which 
makes the lot of the worker easier or affords him a 
better return for his labour, at once puts money into 
the pocket of the master. Every retrograde step, 
no matter how apparently successful at the moment, 
robs both. 




Every industry has its " lost workers " — the men 
and women who disappear. There is little informa- 
tion concerning these, yet it is really by them that 
we must test our new science of Industrial Hygiene, 
our measures for the prevention of disease, and 
our plans for the future, as we shall hope to 


That the subject has not been entirely neglected 
is due in no small measure to the labours of Captain 
Greenwood, who at the request of the Committee 
on the Health of Munition Workers instituted an 
inquiry into the fate of a number of " lost workers " 
among women employed in munition factories. His 
investigation was carried on in sixteen factories or 
sections of factories employing in all some 40,000 
women workers. 

The immediate cause of the research was the fact 
that at a moment when every worker was a national 
asset the disappearance of workers became a national 
danger. Although the majority of operations 
carried out in munition factories did not require a 




I : 


high degree of manipulative dexterity, yet most of 
these led, when often repeated, to an increased pre- 
cision of work, and therefore to increased rapidity 
of output. In the manufacture of cartridge cases, 
for example, a woman did not attain her maximum 
of output till she had been engaged during some 
weeks on her task. It followed that a factory 
at which the operators were constantly leaving 
and being replaced could not attain the same 
level of output as one with a more or less stationary 

This truth holds good in peace time, though in 
a somewhat modified form, for the " lost worker " 
represents, as we have pointed out before, time and 
money spent in promoting his training. Under 
war conditions there was, of course, a constant and 
urgent demand for labour. As a result, discon- 
tinuity, due to seasonal and other variations, was 
practically non-existent. On the other hand, the 
calls of the war certainly encouraged workers to 
serve who were not fitted to do so, or who were 
discontented in their own occupations. These 
latter had no longer the fear of unemployment to 
keep them in tasks they did not enjoy. It will 
therefore be seen that Captain Greenwood's 
findings, while they apply in a broad sense to 
our present industrial conditions, require to be 
understood as war-time material and allowed for 

He points out that he had no earlier work to guide 
him in his search, for no similar inquiry had been 
attempted in this country. In the United States, 


however, certain investigations had been made by 
Mr. Joseph H. Willits in Philadelphia and published 
under the title of Steadying Employment, May 
1916. One example of the results of this work may 
be quoted : 

A particular shop in a carpet mill was selected for 
intensive study. The dates of engagement and discharge 
of the employees were tabulated for the period 1907-15. 
As a result it appeared that 48 per cent of the men and 
38 per cent of the women remained in the service of the 
firm less than 10 weeks. 

A wider and less detailed study was made by 
Mr. Alexander, of the General Electric Company, 
of a large number of factories of all sizes in 
the United States and Europe. From the figures 
collected the fact emerged that on January 1, 1912, 
38,668 persons were employed in the factories, and 
on December 31, 46,796, or an increase of 8128. 
During the same period, one year, 44,365 persons 
had been engaged. So that 36,237 had dropped 
out of employment. That is to say that 5J as many 
people had to be engaged as constituted the actual 
increase in the number employed at the end of the 

Put in tabular form this gives : 

At work January 1 . . . . 38,668 
Engaged during year .... 44,365 

Total 83,033 

At work December 31 . . . 46,796 

Increase at work 8,128 

Lost workers 36,237 


Captain Greenwood's figures from a lai'ge munition 
factory are as follows : 




No. left 


No. left, 


No. em- 
ployed at 
end of 


October . 














Thus 2791 women were engaged and 1125 left 
during the four months July-October. The number 
of engagements was thus 167-5 per cent of the net 
increase in the time. Further, during these four 
months, together with the previous month, the 
firm lost 1516 women workers. In only 663 of 
these cases, or 43-7 per cent, was the cause of leaving 
known to the firm. The others had simply vanished. 

A second set of facts comes from a cordite depart- 
ment of a large munition factory. In this, during 
the twelve months ended August 28, 1916, an 
increase of 624 workers resulted from 1031 new 
engagements among men. An increase of 914 was 
obtained in the same factory from 1527 new engage- 
ments among women — percentages of 165 and 167 
respectively, on the whole rather favourable figures. 

More detailed investigation was possible at a 
factory organized in two main departments — one 
producing cases and bullets and the other carrying 
out cartridge and grenade filling operations. Records 
had been kept by the firm of name, age, previous 
occupation, character, and reason for leaving, which 



permitted data to be collected. Captain Greenwood 
classified the causes of leaving as follows : 

(1) Those who left on account of ill-health. 

(2) Those who left for some sufficient reason other 
than that of health — e.g. : 

(a) Girls who left to get married. 
(6) Girls moving from the district. 

(c) Girls required at home on account of illness or 
to keep house. 

(d) Girls who found the wage earned insufficient. 

(e) Girls discharged because they were unsuitable 
or the factory was slack. 

(/) Girls considered by the factory surgeon to be 
physically unfit, though not complaining of illness. 

(3) Those who left for no reason or for an insufficient 
one — e.g. : 

(a) Girls discharged for misconduct. 

(6) Girls leaving for other employment without 

assigned reason, 
(c) Girls wanting a change or dissatisfied. 

The great majority in the last category gave no 
reason at all. Analysis showed that of 1000 girls 
entering the factory during the war period 132 did 
not outstay the second month ; even if there had 
been no loss from sickness or other reasonable 
cause 1000 would still have been reduced by 10 per 
cent. This 10 per cent were employed for so short 
a period that little useful service w^as rendered. 
They left as was ascertained from mere caprice, 
unwillingness to submit to discipHne, love of change, 
misfits as between task and employee. 

These figures show that at a factory of high 
standing, thoroughly familiar with the industry, 




since it was running in peace time, the absolute loss 
of workers was serious. This factory was compared 
with another in the open country, six miles by rail 
from the nearest town and still farther from any 
large city. The workers travelled at least six miles 
to and fro. 

The loss in this second factory was little more 
than a third of that in the other. In searching 
for a cause of this it was noted that the factory 
with the smaller number of " lost workers " made 
most ample provision for the care of the workers' 
health and comfort. In these respects, indeed, it 
was " probably unsurpassed by any other in the 
country." Any woman absent for more than two 
days without communicating with the management 
was automatically discharged, but in practice all 
these cases were followed up and the sick visited. 
Still another factory was examined. It was situated 
in a Midland industrial city and was found to lie 
between the foregoing in the matter of losses. 

The inquiry next concerned itself with heavier 
work. It was found that the rates of loss at ages 
above 22 were significantly greater than for girls 
between 18 and 22. Captain Greenwood writes : 

It appears that the unusually heavy losses are seri- 
ously contributed to by ill -health and other sufficient 
causes — causes of leaving for which the employees are 
not themselves responsible. 

A heavy type of occupation is thus apparently 
unsuited to women workers over 22 years, 
who are indeed thriftlessly employed on it. For 



in this occupation the ** survival rates " diminish 
with age, a state of matters not met with in Hghter 
work. The older women, it must be remembered, 
are often married. The double handicap of age 
and home duties is apparently sufficient to diminish 
resisting power when heavy work is taken up. 

As regards the effect of sickness it is interesting 
to note that " out of nearly 37,000 women under 
observation for at least a month, illness or medical 
unfitness is given as the cause of leaving nearly 
1651 times." The losses from ill-health are practi- 
cally the same at all ages in light factories, while 
they increase after the age of 22 in the heavy 
factories. Under 23, girls have fewer sickness losses 
in the heavy than in the light factories. 

It will thus be seen that the lost worker, and 
especially perhaps the lost woman worker, is a big 
problem of industry, the solution of which is 
far from complete. We require further data and 
further research, for until the causes of the loss are 
fully understood no cures can be applied. Captain 
Greenwood's investigations have touched only a 
portion of the subject. Yet they have revealed 
one important fact. He declares : 

Of a total number of about 11,000 women who left, 
about 6700 gave no reason for doing so ; this is not a 
satisfactory state of affairs. There is no panacea for 
the disease but there is one promising remedy. This is 
organized welfare work. It has already been suggested 
that in factories where there are organized welfare 
departments the wastage unaccounted for is below the 



Thus, intelligent and sympathetic following up 
of absentees and the visiting of the sick is likely to 
produce good results, and certainly, where a factory 
loses more than 20 per cent of its entrants, an in- 
vestigation on those lines should at once be carried 
out. Further loss can certainly be prevented by 
judicious selection of entrants, both by medical men 
and by the employers themselves. To set a sick 
man or woman to an exacting task is to invite 
failure and to inflict great damage. To set a man 
or woman of one kind of physique or temperament 
to w^ork demanding other kinds is to display mere 

Finally, the human element is at play and must 
be taken into consideration. The heavy " losses " 
of some firms can be traced to the employment of 
ill-natured overseers and managers with whom no 
one can work in comfort. A change in this direction 
may mean a stoppage of the trouble, and so a sub- 
stantial increase in the annual output. From my 
point of view it is clear that the employer who con- 
siders his " human machinery," who cares for it, 
and watches over its welfare, is he who considers 
best his own personal interests. 



The work already accomphshed on this subject is, 
at the best, somewhat fragmentary. Such as it is, 
however, it reveals the very large amount of ill- 
health which exists among women workers, and 
the consequent necessity of supervision and of 
selection. This is very clearly brought out in the 
following tables, which show the chief defects noted 
in a series of factories among women workers : 







No. examined 




Percentage of Defects . 




Digestive System : 

Indigestion, pain, etc. 








Teeth : 

Several carious 




Oral Sepsis 




Artificial .... 




Nervous System : 

Tired, nervous, irritable . 




Headache (frequent) 




Anaemia .... 




Aching and Swollen Feet . 




Muscular Pains (rheu- 

matism) .... 




Nose and Throat troubles . 




Eye Strain .... 






The results speak for themselves. The inquiry 
was voluntary and was undertaken during the war 
at munition factories. Some of the conditions were 
such as to prevent the worker from giving useful 
service, for example, loss of appetite and pain after 
food. At one factory (not included in the table) 
digestive disturbances affected 21 out of 67 
employees. This was traced to bad cooking and 
catering. Bread and butter and tea formed far 
too large a part of the dietary. At another factory 
41 girls were noted as being underfed, and there 
were 43 cases of indigestion among 114 examined. 
This was not due to bad teeth, but seems to have 
occurred because a long bicycle ride had to be taken 
just after meals to get to work. Cooking, too, was 
deficient in quality. 

Nevertheless, bad teeth were common enough. 
The workers seem to have believed that these did 
not much affect their digestion, but in view of exact 
scientific knowledge on this subject such a view 
cannot be accepted. There can be no doubt that 
the opinion of the examining physician is sound — 
that bad teeth " are bound to affect the health 
adversely and are, indeed, responsible for malaise 
and headaches with which the workers do not 
associate them." Such a report as the following 
is a disgrace to modern civihzation and, moreover, 
reveals a great lack of business acumen on the part 
of both employer and employed : 

The teeth were usually extremely bad, dental hygiene 
seemed unknown, and pyorrhoea occurred in most of the 
women over 30 years of age. Considerable reluctance 



was shown at the prospect of a visit to the dentist, and 
conservative treatment was rarely sought in time even 
by young girls of otherwise good appearance. There 
was a general impression that stopping always hurt more 
than having a tooth out, and as a result no treatment 
was sought. 

We shall have occasion to return to the subject 
of dental care in industry. It is enough at present 
to note that among young women workers, that 
is to say, among the mothers of future generations 
of workers, dental decay is prevalent. 

Headache was another frequent complaint. It 
was found to be due in some cases to mere tiredness, 
in others to noise in the factory, bad conditions of 
travel, insufficient fresh air and exercise. In stiU 
another group of cases bad teeth, bad digestion, 
and anaemia were the causes. At one factory, badly 
built and crowded with machines, no fewer than 
40 out of 67 girls complained of headache. This 
they attributed to the noise and the long periods 
during which they had to stand on their feet. 

The prevalence of swollen and aching feet was 
commented on. This most disabHng condition ap- 
peared to be due to the circumstances of work and 
especially the nature of the floor and the lack of 
provision of seats. At one factory where the heating 
was defective and the floors were uneven and wet, 
muscular pains and swollen, aching feet were common. 
At another factory varicose veins seemed to be 
common among the older workers and to be associ- 
ated with foot trouble. The floors were not satis- 
factory. In addition to these troubles a number 


of ailments peculiar to women were met with. No 
doctor had been consulted in most cases, and thus 
disabling diseases were going on unchecked, and were 
literally sapping away the strength which should 
have been available for work and for the future. 

The modem employer who engages many women 
workers cannot, it may be supposed, view such a 
state of matters as exists at present without mis- 
giving. As soon as he recognizes how many of the 
women engaged in industry are unfit to a greater 
or less degree he will perceive that their work is 
bound to be as unfit as themselves. It is thus to 
his interest that welfare work among women should 
be begun at once, and that medical advice and help 
should be available. A bad floor may, for example, 
conceivably save the price of a good one. And so 
long as the evil effects of a bad floor are not under- 
stood this may seem to be a justifiable economy. 
But when these evil effects have been made manifest 
— the sore feet, the pains, the headaches — and when 
the high cost to the employer involved in the effects 
has been set out, the " economy " will appear rather 
as a ruinous waste. The following percentage table 
showing the results obtained at eight different 
factories deserves close and anxious consideration : 


OF Table Defects 

Percentage of 

<B . 



Teeth (includ- 
ing artiflcial). 

O o 

> 4> 













cS °3 














Most of these defects could have been prevented 
by the exercise of a little care. 

This becomes more evident when another aspect 
of the subject is taken into consideration — that of 
industrial fatigue. In earlier chapters we have dis- 
cussed the bearing of this insidious disabiUty on out- 
put, and shown, on scientific evidence, that there 
exists no greater enemy of output and efficiency. 
In the eight factories mentioned above an esti- 
mate of industrial fatigue was made, and the girls 
were divided into three classes, those in good 
health, those showing some sign of fatigue or ill- 
health, and those showing marked signs of fatigue 
or ill-health. The following table shows the 
results : 




Per cent. 

Per cent. 

Per cent. 

Factory A . 




B . 




„ C . . 




„ D . 




„ E . 




„ F . . 




„ G . 




„ H . 




It needs no emphasizing that the lot of an em- 
ployer controUing Factory D, with 71-3 per cent 
healthy workers and 26-1 sHghtly fatigued, and only 
2-5 markedly fatigued, must be a happier one than 
that of an employer controlhng Factory E, with 
respectively 38-6 healthy, 57-2 slightly fatigued. 


and 4-02 markedly fatigued. The percentage results 
for the whole eight factories were : 




SUght Fatigue. 

Marked Fatigue. 




The causes of the fatigue were ascertained as 
far as possible, and were put down to " heavy work, 
especially when associated with long hours, age and 
general unsuitability for particular work, length of 
service, insufficient attention to ' welfare ' inside 
the factory, home duties, mental anxiety, transit, 
dietary, etc." The nature of the work a woman 
may properly be asked to perform is a subject 
which demands very careful consideration. 

In the inquiry we have described it was estab- 
lished that considerable fatigue was shown by girls 
under 18 who were working long hours in unsuit- 
able conditions. Improving these conditions at once 
reduced the extent of the fatigue, and so, of 
course, increased the value of the work done. 
From the national point of view the induction of 
fatigue in girls of this age is a crime. It means a 
lowering of vitaUty which may never be adequately 
compensated for and which may therefore affect 
the welfare and the working capacity of the next 

Length of service in the case of women, as in the 
case of men, renders the healthy more fit for their 
^ork — because they have become accustomed to 
it, but more and more adds to the burden of the 


unfit. Thus the following table compiled from one 
factory during war conditions shows how many 
girls displaying shght signs of fatigue in 1916 were 
displaying marked signs in 1917. Those showing 
no signs (the healthy) had meantime increased in 
number : 


Slight Fatigue . 

Marked Fatigue 

January 1916. 

Per cent. 

July 1916. 

Per cent. 

October 1916. 

Per cent. 

Thus at first a number of the girls grew more 
expert and so felt fatigue less— and these moved up 
from the second to the first class. Then, after a 
year of work, another group which had shown only 
sUght signs of fatigue move downwards from the 
second to the third class. 

Insufficient attention to welfare among women 
workers is thus a serious ill which is costly to the 
nation and to industry and which demands both 
prevention and cure. This is a very complicated 
problem, because it involves consideration of the 
amount of work, if any, which married women and 
young mothers should be allowed by the State to 
carry on. It involves, too, an examination of the 
breaks in work which must occur at those periods 
when the duties of motherhood demand full atten- 
tion. The matter will have to be faced at an early 
moment, because the war has driven so many 
women into industry that a sudden crisis has been 



The case for an extension of welfare work to 
women is thus a very sound one. Those firms who 
have recognized the need and acted accordingly 
are unanimous in acclaiming the advantage of the 
steps taken. Those firms who lag behind are stand- 
ing in their own Ught. The day is certainly at 
hand when legislation on this subject will be under- 
taken on a large and comprehensive scale. 






The whole position of juvenile employment in this 
country is about to undergo a change as the result 
of the new Education Act. It is therefore important 
that employers should understand what proposals 
are being made and in what manner they can assist 
the authorities in caring for the health of the youth 

of the nation. 

In his report on the School Medical Service during 
1918, Sir George Newman, the Chief Medical Officer 
to the Board of Education, and also the Chief 
Medical Officer to the Ministry of Health, devoted a 
special section to the question of juvenile employ- 
ment. Under the Children's Act of 1903 as amended 
by the Education Act of 1918 it is, he pointed out, 
provided that children under 12 years of age shall 
not be employed at all; children under 14 years 
of age shall not be employed in street trading ; 
children over 12 years of age may not be em- 
ployed (1) on Sundays, (2) on schooldays before the 
close of school hours, and (3) on any day before 

6 A.M. or after 8 p.m. 




Sir George Newman recommended that the school 
medical officer should report periodically upon the 
employment of all children of school age and its 
effect on their health ; should examine annually aU 
" leavers " as required by the Code and report on 
their fitness for employment ; should examine em- 
ployed children at once ; and later, from time to 
time, re-examine them, certifying to the Authority 
if and when the employment is injurious or pre- 
judicial to the health or physical development of the 
cliild ; should co-operate with the certifying factory 
surgeon of the district in selecting children for factory 
work ; should furnish, on application, the welfare 
supervisor of factories and workshops where the 
child is employed with the latest school medical 
reports on the child's physique ; finally, should co- 
operate closely and continuously with the Juvenile 
Employment Committee or with the Labour Ex- 

It will be seen that this programme, if carried out, 
will afford an employer a means of selecting suitable 
young people for his works, and will relieve him to 
some extent of the responsibility of engaging those 
who are unfit for the labour they may wish to 
take up. 

In 1917 the Minister of Labour addressed to the 
principal employers' associations and trade unions 
a letter informing them that the War Cabinet had 
approved the principles of the report on Joint Stand- 
ing Industrial Councils which were issued by the 
Reconstruction Committee appointed to consider 
the relations between employer and employed. A 





number of these councils have now been formed. 
Almost invariably there has been included in the 
constitution of these councils a clause deaUng with 
the health conditions obtaining in the industry. 
These joint industrial councils may therefore be 
expected to assist in looking after the health of the 
young people employed in the industries over which 
they preside. Sir George Newman afforded an out- 
line of what he regarded as an enUghtened arrange- 
ment for the care of young employees, and declared 
that the more progressive firms are already in pos- 
session of the facihties : 

1. A medical officer should be appointed by the 
firm and may be whole-time. He has now in some 
cases a set of rooms at his disposal — a consulting- 
room, a massage-room, a rest-room, a dispensing and 
a dental surgery. Advice is obtained free by any 
one in the firm's employment. In a number of cases 
treatment and medicine are also free. Letters 
admitting to hospital are available, and visits are 
paid to homes within a certain radius. 

2. Employees should be inspected on entry by 
the firm's own medical officer. A dossier is opened 
in some cases in which a health-card is kept. The 
examination includes inspection for cleanHness, 
teeth, eyesight, hearing, throat, glands, lungs, heart, 
anaemia, height and weight. Medical defects in- 
volving rejection include heart disease, lung disease, 
marked deformity, and may include educational 
retardation and dental defect. Skin defects of the 
hands may involve postponement of employment 
till they are cured. 


3. Men and women welfare supervisors, to under- 
take the care of all matters relating to the health 
of the workers, should be appointed. A certificated 
nurse is often engaged for this work, and her duties 
include attention to patients coming to the dis- 
pensary and the visiting of the homes of absentees 
and reporting cases of illness to the medical officer. 
They also include inspection of hair, skin, and hands 
of girl workers. A rest-room is often provided. 

4. Full-time or part-time dentists have been 
appointed to inspect all entrants, to treat juvenile 
employees by conservative methods, and to provide 
artificial dentures where necessary. In some cases 
the firm pays for this treatment up to 21 years 
of age ; in other cases dentures are provided at 
cost price. 

5. Baths, with hot and cold water, dressing 
cubicles, towels, and so on, are frequently provided 
free of charge. 

6. Physical training should be encouraged. 
Athletic clubs are in existence in many factories and 
sports grounds have been provided. Swimming- 
bath and gymnasia are also part of the equipment 
laid out by some employers. 

7. Attendance at continuation classes is now 
made compulsory by some employers for workers 
under the age of 18 years. These classes, as a rule, 
occupy three hours per week for three years. 

8. Some firms have instituted a second medical 
examination six months after admission to their 
employment. This second examination sometimes 
has the result of changing the work of the employee. 



9. First aid. 

10. Convalescent - homes, holiday - homes, and 
camps. . 

11. Remedial exercises are now much used and 
should be encouraged. Some firms provide a 
physical culture class. for girls needing special atten- 
tion. In other cases remedial exercises are given 
in the massage-room of the medical department 
under the supervision of the woman medical officer. 

12. Provision of meals. 

Medical inspections have recently been carried 
out at the London Centre for Juvenile Unemploy- 
ment, and a valuable report has been issued by Dr. 
Hamer, the Medical Officer to the London County 
Council. Some 673 boys and 45 girls, between 
14 and 18 years of age, obtaining the unemploy- 
ment donation were examined and it was found 
that 318 boys (47 per cent) and 16 girls (35 per 
cent) were in need of treatment. 

The condition of the clothing of the boys was 
generally found to be better than that of boys just 
leaving school, only 2-5 per cent being classed as 
poor. The state of cleanliness, especially as regards 
" heads," was good, 99 per cent having heads com- 
pletely free of vermin. The nutrition of the boys 
presented greater variation than that of boys leaving 
school. Forty-one per cent were classed as " ex- 
cellent," as against 25-2 of leaving schoolboys. On 
the other hand, 49-3 per cent were " normal," as 
compared with 69-5 per cent, and 9-7 per cent were 
'' below normal," as compared with 5-3 per cent. 

The condition of the teeth was distinctly worse 


than that of boys leaving school. It is noted, how- 
ever, that these boys left school when the Council's 
arrangements for dental treatment were less fully 
developed than is now the case. Nose and throat 
troubles were fairly prevalent, for 4-7 per cent of the 
lads had enlarged tonsils ; on the other hand, only 
•7 per cent had adenoids. But these conditions tend 
to disappear during adolescence. 

Fifty-eight per cent of the boys had normal 
vision, but 25-7 per cent had a high degree of visual 
defect. The figures for boys leaving school were 
respectively 57-6 per cent and 21-7 per cent. Only 
1 per cent had ear disease. Five per cent stammered, 
as compared with 1 per cent leaving school. The 
percentage of cases of heart disease was identical in 
the two groups — viz. 3-4 per cent, but anaemia was 
found in a less number of cases in these lads than in 
the schoolboys. Lung diseases other than consump- 
tion were rare. Consumption was present in -3 per 
cent, compared with -2 per cent of boys leaving 
school. For other forms of tubercle the figures were 
•7 per cent and -2 per cent respectively. The re- 
mains of rickety deformities discovered were 4-6 per 
cent, as against 1-8 per cent in boys leaving school. 
For other types of deformities the figures were 5-5 
per cent and 1-8 per cent respectively. 

We have given this report in some detail because 
it opens some important questions regarding the 
effects of employment on the young boy. This is 
most striking in the case of rickets and other de- 
formities, which were much more prevalent in the 
older boys than in the boys leaving school. On the 



other hand, heart trouble had not increased after 
school fife. It is argued that if employment was 
proving too strenuous the heart would have given 
way first and that consequently the increase of 
defom^ity was not due to employment, but is rather 
to be ascribed to the fact that a progressive tendency 
was present in certain of the lads. In the same way 
the relationship between the onset of varicose veins 
and employment requires further study, for it is by 
no means certain that this condition is to be ascribed 

to the work at all. 

The final recommendations made are that there 
should be definite co-operation between the industrial 
bodies, the local education authority, the sanitary 
authority, the certifying factory surgeon, and the 
employer. The records of a boy's school medical 
history are available, and should be passed on, when 
he enters employment, to the certifying factory 
surgeon. The latter has his duty of acceptance, post-^ 
ponement, or rejection in regard to the lad's employ- 
ment. The employer is responsible as regards the 
working conditions involved in the employment. 

Secondly, the selection of the young employee 
" from the point of view of physical fitness for 
factory conditions is a matter of supreme import- 
ance." On it may depend the necessity for the 
adaptation of the work to the workers' condition. 
There is need, too, for more adequate arrangements 
for the detection and treatment of disease, since 
impaired health means impaired work and reduced 
output. The factory must be hygienic and facilities 
for physical training must be promoted. 





The industrial revolution in the United Kingdom 
took men, women, and children from the fields to 
the towns, from the chamber- workshop to the mill, 
from an evil environment to a worse. It turned the 
discomforts and Umitations of the j)oor into a rigid 
system, a system which left indelible marks on the 
physique of the people. 

The first signs of reaction came in the early part 
'bf the nineteenth century, when the State found 
that its children were being ruined in body and mind 
by the conditions and circumstances of their employ- 

Official reports in 1816, 1819, and 1832 and subsequent 
years furnish overwhelming medical evidence of the 
gravity of the physical injury due to the premature, pro- 
longed, or unsuitable employment of children. There 
is now a century of proof. 

Nor was such employment affecting children only. 
" We manufacturers," wrote Robert Owen, " are 
always perfecting our dead machinery, but of our 
living machinery we take no care." Another writer 


declared that *' to use up or damage its women by 
setting them to hard wage labour in mill and work- 
shop is probably the greatest human waste a nation 
can practise or permit." The result of these warn- 
ings was that steps were taken to find out the effects 
of occupations of various kinds on the men and 
women engaged in them. 

It then became clear that every industry in 
greater or less degree affected the death rate, or, in 
other words, that, of itself, without adequate pre- 
caution or safeguard, each trade added to the loss 
of human fife and health, and so to the weakness of 
the nation. Tatham showed, and the chief medical 
officer of the Ministry of Health quotes him as an 
authority, that if the comparative mortality figure 
for the agricultural labourer be 602, that for the 
shoemaker is 920, for the hairdresser 1099, for the 
chimney sweep 1311, for the glass maker 1487, for 
the lead worker 1783, and for the file maker 1810. 
The contrast is even more marked for sickness, dis- 
ablement, and accident. 

If we are to judge by the attitude of its Chief 
Medical Officer the Ministry of Health will devote 
its attention to the following points : 

(a) The careful selection of workers on engagement, 
and periodical medical supervision (including observa- 
tion as to output, lost time, sickness, physiological 
requirements, etc.). 

(6) The hours of employment — shifts, breaks, spells, 
pauses, holidays, Sunday work, night work, overtime. 

(c) The factory or workshop environment — design, 
structure, sanitation, cleanliness, heating, temperature, 


ventilation, lighting, sanitary accommodation, washing 
facilities, cloakrooms, seats, rest-room, surgeries. 

(d) The personal well-being of the worker — the in- 
dustrial employment of women, incentive, food supply, 
and drinking water, canteens, protective clothing, lifting 
weights, welfare conditions, rest, recreation. 

(e) The effect of occupation on health — fatigue (due 
to excess in duration of labour, specialization, repetition, 
strain or speed), sickness, injuries, accidents, industrial 
disease (poisoning by lead, phosphorus, arsenic, mercury, 
anthrax, dust, fumes). 

These matters, it is pointed out, concern 130,000 
workshops and 150,000 factories in which 12,000,000 
people spend a third of their lives. " Whatever 
was the case before 1914, the experience of the war 
has demonstrated beyond all question that industrial 
hygiene forms an integral part of the practice of 
preventive medicine." 

Nor, indeed, does the State lack financial and 
economic support for the policy which it is about 
to adopt on humanitarian lines. The figures pub- 
lished of the economic loss from sickness and dis- 
ability among the working population are appalling. 
The estimated number of insured persons in England 
entitled to medical benefit for 1914 was approxi- 
mately 10,300,000. Of this number approximately 
5,800,000 applied for and received medical attention, 
being 56 per cent of the whole number entitled to 
treatment. In other words, over half the total 
insured population in that last normal year before 
the war came under review by the Insurance Prac- 
titioners within the twelve months. In certain 



industrial practices the proportion claiming and 
receiving treatment was as high as 70, 75, or even 
80 per cent of those eligible. 

When we come to reckon this in terms of time 
lost from employment we get a glimpse of the 
national loss entailed. For the year 1916 (the latest 
for which figures are available) the amount paid in 
sickness benefit in England only for men was 
£3,409,914, and for disablement benefit £587,671. 
Taking the maximum rate of sickness benefit (10s. 
a week) and of disablement benefit (5s. a week) these 
figures represent 6,819,828 weeks' sickness and 
under disablement benefit 2,350,684, a total of 
9,170,512 weeks. For women the figures are not less 
alarming. They total 3,473,424 weeks' sickness. 
Thus at least 12,643,936 weeks' work were lost during 
the year 1916, or a period equal to 243,000 years. 

The following table gives a summary of the ex- 
penditure of approved societies (England and Wales) 
on sickness and disablement benefits in the years 
1914, 1915, and 1916 : 


Sickness Benefit. 

Disablement Benefit. 





1914 . 

1915 . 

1916 . 





Total for three 

yeara . 





Average per 
annum . 






The amounts per annum given in the above table 
represent a minimum average of 14,295,724 weeks 
of sickness (at 10s. per week for men, and 7s. Gd. 
for women, and 5s. disablement for men and women), 
or a period of upwards of 270,000 years. " This 
is equivalent to a loss to the nation every year of the 
ivork of upwards of 270,000 persons. Moreover, no 
account is taken bf the labour and expense involved 
in the care, nourishment, and treatment of these 
sick persons during the 14,000,000 weeks of their 

This mass of sickness is practically confined to 
the workers of the country. A great part of it is 
preventible and the prevention depends in large 
measure on industrial hygiene — that is to say, on 
good environment during the working day. It is 
only necessary to think of tuberculosis to realize 
that infection must often be spread by means of 
unsuitable surroundings, lack of inspection, ventila- 
tion, and so on. Indeed, it was found that certain 
communicable diseases ranked high in the list of 
those sending insured persons to consult their 
doctors. Thus, bronchitis, bronchial catarrhs, nasal 
catarrhs, and colds accounted for a proportion of 
181-3 per 1000 cases ; pneumonia and alUed condi- 
tions for 69-2 ; skin diseases for 47-1 ; abscesses and 
boils for 49-1. Injuries and accidents claimed 60-7, 
and digestive troubles — the origin of which is too 
often to be found in badly planned meal hours and 
unsatisfactory works' canteens — for 143-1. 



There has never been a time in which waste, and 
especially industrial waste, was so inexcusable. 
Economy is not only a virtue, it is a necessity. All 
that is superfluous must go. 

It is for this reason that any methods which 
have as their object the recovery of lost time or 
lost effort deserve the careful consideration of 
employers. And when it can be shown that the 
method has already, in other hands, yielded valu- 
able, nay rich, results, the importance attaching 
to it cannot be exaggerated. For this reason the 
study of motion in industrial activity is bound to 
attract great attention during the coming years. 

This study has been carried a step farther by 
the pubhcation of a report of the Industrial Fatigue 
Research Board on Improved Methods in an Iron 
Foundry. This report, curiously enough, seems 
to have been issued without knowledge of the 
remarkable work of Taylor and his disciples, which 
has earned for this branch of industrial medicine 
the title of " Taylorism." In the circumstances, 




it will be helpful to explain the progress which has 
already been made. 

It was observed long ago that the amount of 
effort usually expended in the carrying out of any 
given action can be greatly reduced if a Uttle care 
is exercised. Every man, left to himself, wastes 
his energy. He puts too much force into his move- 
ments, he carries out unnecessary movements, he 
calls into play groups of muscles which need not 
be used, and so on. This he tends to do to a greater 
extent when he is learning a new operation, and to 
a less extent when he has become proficient — just 
as the child writes at first with all its muscles tense 
and its tongue out, but latterly with only a small 
action of the wrist. 

Now this unnecessary movement, this redupUca- 
tion of movement represents an enormous body of 
lost time and lost effort, and so of lost output— 
a loss, indeed, very comparable to that experienced 
in the combustion of fuels. It was the object of 
Taylor and others to recover this loss, to eUminate 
the superfluous movements and then by a process 
of re-education to ensure that workers should follow 
a standard in which waste and loss would be reduced 
to the lowest possible proportions. 

The results achieved surprised even their pro- 
ducers, and the study of movement in industry 
became a recognized method. Its objects were two- 
fold—the determination of what was useless and 
the determination of the most efficient method of 
using the useful. In other words, accurate measure- 
ment of each of the "movements" of industry 



became essential. It was necessary, for example, 
to watch the bricklayer at work, to observe his 
methods, to see whether or not he was expending 
more movement on each operation of his calHng than 
was essential to its performance. The same thing 
applied to other trades. 

A beginning was made with a stop-watch, but 
it was found that this method was not accurate 
because there was the personahty of the man with 
the watch to be allowed for. So photography, and 
later the cinematograph, was called into play. But 
it was essential to have a record not only of move- 
ment, but also of the timing of movement if the 
work was to be of any real value. Consequently 
a machine called a microchronometer, capable of 
recording down to a miUionth part of an hour, was 
included in the picture, with, beside it, a good 
reUable clock to serve as a check on its readings. 
Later, the worker and the timepiece were placed 
in front of a cross-sectioned background so that 
the motions and movements might be more exactly 
located in space. 

Thus in the same photographic film there was 
an exact record of the movements made, an exact 
timing of them, a check upon this timing, and a 
means of locating them. The excellent commercial 
results achieved prompted further progress in the 
study, for in one shop alone, where 18 to 20 textile 
machines had been assembled, it was found possible, 
after study, to assemble 66. The saving was the 
direct result of the micromotion study combined 
with the improved placement or assignment of the 



workers to the work, and the improved surround- 
ings, equipment, and tools with which the work 
was done. 

It was necessary, however, not only to eliminate 
needless motion, but also to teach beginners how 
to avoid it. 

The " average engineer," wrote Frank and LiUan 
Galbreth in a paper presented at the second Pan- 
American Congress at Washington in January 1916, 
'* who becomes, through his training and the necessi- 
ties of his work, a good visuaHzer, even though he 
is not one by nature, often fails to reaUze the small 
capacity for visualization possessed by the average 
person. A long experience in teaching in the in- 
dustries made this fact impressive and led to the 
invention of the cyclegraph, and later the chrono- 
cyclegraph method of recording, in order to aid the 
non -visualizing worker to grasp motion economy 

The cyclegraph consists of a small electric light 
which is attached to the hand or other moving part 
of the worker's body. In this way it is possible 
to obtain a line of light on a photographic plate, 
which Une represents the course of the movement. 
The time occupied is supplied by a clever device 
whereby interruptions are introduced into the line. 
The lamp on the man's hand is caused to flicker, 
so that instead of a steady line on the plate a dotted 
line appears. Each dot represents a second or other 
unit of time. In addition, it has been found possible 
to cause the lamp to extinguish slowly and to light 
again quickly at each interruption, so that each of 




the dots on the plate is shaped like an arrow-head. 
This affords an indication of the direction of the 


A stereoscopic camera is used in examining the 
photograph thus obtained, so that one is enabled to 
see the Une of movement in three dimensions. 
Finally, it has been found possible to attach a number 
of lights to the same man, and so to record not only 
motions of the hand, but also of the feet and other 
parts of the body. 

The apparatus used has been simpUfied, so that 
it is not expensive. The records possess a permanent 
value and are of great use for teaching pupils 
standardized movements. To this end the pupil 
not only studies the photograph of the movement, 
he is also taught to make an exact model of the 
line of movement out of wire suitably bent and 
twisted. The excellent results obtained by the 
making and use of these models are thus described : 

The motion models not only enable one to visualize 
the non-material and intangible motion path, but also 
make possible the teaching of motions through the eye 
or through the touch, thus appealing to vision, touch, 
and the kinesthetic sensations. . . . Through the study 
of the motion path and through a comparison of such 
graphs or models, showing the paths of different operators 
doing the same kind of work, it is possible to deduce the 
most efficient method and to make this a standard. 
Moreover, each standard motion path is a help towards 
deducing other standard motion paths. Through an 
intensive study of motion paths followed in doing 
different kinds of work efficiently, there has come a 






recognition of the indications of an efficient motion, its 
smoothness, its lack of hesitation, its regular normal 
acceleration and retardation, and its use of habit. 

Inasmuch as it has been found that the same 
motions are used in carrying out widely different 
tasks, it is possible to apply the findings of one 
trade, with modifications, to other trades. Moreover, 
by means of a system of charting it has been found 
possible to classify trades according to the members 
of the body most used in them. Thus, one trade 
uses the left hand to a far greater extent than the 
right, and when the right is used at all it is doing 
what is called " transporting empty." Only for 
two short intervals are both arms occupied simul- 
taneously. It is evident that the work of the right 
hand can be transferred with a slight change in 
conditions either to the left hand or to the feet. 
The importance of this knowledge where disabled 
soldiers are concerned can scarcely be exaggerated. 

The results of the application of these methods 
of motion study and methods like them are, as we 
have stated, given in the report of the Industrial 
Fatigue Board on work in an iron foundry. This 
report gives no indication that the full measure of 
scientific help available was made use of. Indeed, 
it is rather suggested that the means employed 
were quite simple, though clearly founded on the 
principles we have enunciated. Nevertheless, the 
results achieved were very remarkable. 

The foundry in question is the Derwent Foundry 
at Derby, and the application of scientific method 



is due to the managing director, Mr. Jobson. In 
May 1915 the foundry began to work for the Ministry 
of Munitions, and it continued to do so till the end 
of the war. The Ministry estimated its capacity 
for moulding and casting hand-grenades and fuse- 
hole plugs at 3000 articles weekly. 

In August 1915 Mr. Jobson began to apply his 
study of motions, and by August 1918 a capacity 
of over 20,000 plugs weekly had been reached. Not 
only so, but Mr. Jobson 

found that a firm he visited recently was pressed to 
turn out 5000 plugs, whereas his own works, with less 
plant employed on the job, pelded an output equivalent 
to over 20,000 per week. 

Again, during the period August 1916-18, the 
value of the output from his works upon this parti- 
cular job increased fivefold, although the price paid 
by the Ministry was meanwhile reduced by 13-3 
per cent. These results were obtained by a judicious 
combination of movement study, training of workers, 
improvements in appUances, shorter hours of work, 
and higher wages. The employees were told: 
" We are out for higher wages, less hours, and more 
output. WiU you help us ? Are you wilUng to 
have your movements studied so that we can find 
out the best way, adopt this as standard, and cut 
out useless and unproductive movements ? " 

The men consented. The motions were analysed 
with the aid of a stop-watch merely. Tools and 
materials employed were arranged appropriately, 
and such movements as could be performed simul- 



taneously were combined. In the case of moulding 
and casting 90 per cent of the increase in output 
is put down definitely to improved efficiency on the 
human side. Over 20 per cent of this is ascribed 
to training. 

Moreover, as soon as training was begun, the 
working hours were reduced from 54 to 48 per week. 
Instead of starting at 6.30 a.m. they began at 8 a.m. 
every morning, working until 5.45 at night, with 
an hour's interval from 12.30 to 1.30 for lunch, 
save on Saturday, when work stopped at 12.15. 
These hours were continued unchanged after the 
men had been trained. During training each man 
was paid by day rate, his daily wage being raised 
to about 25 per cent above the standard rate for 
the district. 

As stated, the new method increased output by 
more than 300 per cent for jobs which include 
machine work. For example, a job which before 
the war gave an average output of 48 per day of 
10 hours was standardized under the new system 
at an output of 147 per day of 8 J hours. This 
meant an increase in hourly output by nearly 284 
per cent, an increase which was regularly surpassed 
by trained adult workers. 



Probably there is no more momentous factor in 
modern industry than the ventilation of the factory. 
This may sound an extreme, even an exaggerated 
statement ; it is neither. The reason why employers 
have not devoted more attention to the subject is 
to be found in the fact that they are ignorant 
of the meaning of ventilation and of the part 
which it plays in maintaining active, healthy 

The old idea of ventilation was that the object 
aimed at should be to provide a plentiful supply of 
fresh air. It was stated that so many cubic feet of 
air were necessary for each inhabitant of a room. 
It was confidently asserted that large quantities of 
oxygen must be available at all times in order that 
the blood might have a liberal supply of this gas. 
Oxygen, declared the exponents of these views, is 
the first essential of all energy, and unless it is present 
in great quantity the worker will become intoxi- 
cated with his own waste-product, carbonic acid 
gas, and be rendered inefficient. 





This attitude was the direct outcome of the great 
physiological work which had revealed the secret 
of the circulation of the blood and the mystery of 
the exchange of gases which goes on in the lungs. 
The physiologists were able to point to the fact 
that each time a man draws a breath he takes oxygen 
into his lungs and each time he expires air from his 
chest he drives out carbonic acid gas. They natur- 
ally assumed that unless the supply of oxygen was 
kept at a high level this vital process might come 
to an end. 

The result was a tremendous " boom " in what 
may be described as oxygen ventilation. The very 
name of this gas acquired a deep significance. It 
was mentioned with reverence, and everything 
which seemed to militate against its prevalence 
was looked upon with grave suspicion. Buildings 
with low roofs were taboo ; elaborate schemes 
were invented whereby the air containing carbon 
dioxide gas might be got rid of and oxygen sub- 
stituted for it. 

Unhappily the results achieved, though they 
were important, were not sufficiently great to 
warrant the idea that the whole truth of this matter 
of ventilation had been revealed. So that a re- 
consideration of the problem became necessary. 

This reconsideration began with a return to the 
study of the healthy body and its reactions to its 
environment. It was then seen that in the 
enthusiasm for oxygen and for what is called 
" gaseous exchange " a very important aspect of 
respiration had been left out of account, namely, 



the function of the lungs in getting rid of surplus 

heat. , . /. 1 

In the lungs the blood is exposed to air of a lower 

temperature than itself, and heat passes from the 
blood to the air and is got rid of. So that the 
lungs are a valuable means of keeping the bodily 
temperature even, just as the skin is. 

But the matter goes farther than this. The skin 
itself plays a tremendous part in the cooUng process 
and it also acts as one of the great sense organs of 
the body. By means of the skin aU tactile stimuU 
are received and transmitted to the brain, and the 
general responses of the individual depend therefore 
upon the " flow of sensations " to this great sensory 

area. , . , 

It was now evident that any circumstances which 
(1) interfered with the cooHng mechanism of lungs 
and skin • (2) prevented the continuous stimulation 
of the skin-and possibly also of the lungs-so 
necessary to bodily vigour ; and (3)-the old idea- 
diminished to a dangerous extent the exchange of 
gases must seriously affect the well-being of the 
man or woman concerned. Thus the problem of 
ventilation assumed a new^ complexity and a new 


The first-fruits of the study of it, which began 
when these considerations were appreciated, was 
the recognition of the importance of currents of air. 
It was pointed out that in most of the rooms in which 
ventilation seemed to be bad there was abundant 
oxygen for aU needs. It was the stillness of the air 
rather than its impurity which caused the trouble. 


In the absence of current, or movement, the in- 
habitants of the room ceased to receive any stimuli 
on their skins and consequently experienced a sense 
of lassitude, of heaviness, which deprived them of 
the power to work or to think. The value of a fan 
was thus perceived at once. The fan helps not 
because it draws out impure air from a room, but 
because it creates a current of air. The older fans 
were fitted in holes in the wall ; nowadays fans are 
fitted anywhere, preferably in such a position that 
their action sets up a good strong movement of the 

But there was another factor to be considered 
in these badly ventilated rooms — the heat of the 
room. If the room was cool the absence of currents 
of air was much less vital a matter because the 
stimulus of the cool air was often of itself enough to 
maintain the inhabitants in comfort and activity. 
A hot room, on the other hand, soon became in- 
supportable unless the air in it was moved about. 
Moreover, the heat of the room prevented cooling 
of the body from lungs and skin, and so increased 
the discomfort and lassitude. And if the air in the 
room was damp as well as hot things became much 
worse because then evaporation of sweat could not 
occur and another important method of cooling 
was put out of gear. 

The whole of this vast and complex problem has 
the most important bearing upon work in factories 
and shops because unless it is understood and unless 
action is taken a great deal of energy which might 
be usefully employed in production will go to waste. 


It is therefore gratifying to find that the Medical 
Research Committee has devoted attention to it 
and has assisted Dr. Leonard Hill, the well-known 
physiologist, in his researches into the subject. Dr. 
Hill has published a special report to the Committee 
which, though it is of a highly technical nature, 
contains important information. He points out : 

*' Of the inflow of sensations which keep us active 
and alive, and all the organs working in their ap- 
pointed functions, those from the great cutaneous " 
(skin) " field are of the highest importance. The salt 
and sand of wind-driven sea-air and sea-baths act 
on the skin and brace up the body. The changing 
play of wind, of Ught, of cold, and warmth stimulate 
the activity and health of the mind and body. 
Monotony of occupation and external conditions for 
long hours destroy vigour and happiness of, and 
bring about the atrophy of disease in, man." 

He then goes on to point out that for the purpose 
of controlling the heating and ventilation of rooms 
the thermometer has acquired an authority it does 
not deserve. It is not, as we have insisted above, 
the actual temperature but the cooling power of 
the air, dependent not only on temperature but 
on movement, the radiant energy of the sun or 
other source received by the skin, the drying power, 
dependent on humidity, movement, and radiant 
energy which affects the nervous apparatus of the 
skin on which the maintenance of health and vigour 


So important are these facts that Dr. Hill goes 

the length of declaring that : 

i ; 


" In a factory, slim and fat men doing the same 
physical labour require very different rates of cooling, 
and to effect the greatest efficiency of working should 
be grouped in different shops differently ventilated." 

The ideal method of warming and ventilating 
rooms then would give radiant heat, a warm floor, 
and agreeable movements of cool air — the condi- 
tions of a sunny spring day out of doors. To some 
extent those conditions can be obtained in factories, 
and their attainment will assuredly prove valuable 
to the owner. It will result in clear heads and 
active muscles among his workpeople, and that 
sense of freshness which always conduces to good 


The case of the Rand IVIines is cited as being an 
illustration of defective ventilation— in very difficult 
circumstances — which is paid for at a high price. 
" The loss of Ufe, of health, and the economic loss 
of labour at these mines continue at a very high 
figure." But the same defects are found much nearer 
home and are due, in this climate, to ignorance and 
apathy. If only employers realized that they 
themselves are paying a high price for their failure 
to improve matters a change would soon be brought 
about. Indeed, the trouble is not confined to 
works and factories. Dr. Hill writes : 

In the Chamber of the House of Commons the venti- 
lating current is driven up through the floor in such a 
way as to cool the members' feet while their heads are 
exposed to more stagnant air. Cold feet and stuffy 
heads result — ^just the wrong conditions for legislators. 
Certain members are susceptible and cOmplain greatly 




of the ventilation, others do not. Noses vary. The 
thermometer, it is true, shows a uniform temperature of 
63° F. : but the Kata-thermometer shows that the 
members' feet are cooled at a rate which is 40 per cent 
or more greater than the cooling of their heads. Sitting 
on a bench in the House of Commons I found my left 
nostril, narrowed by the deflected septum, become com- 
pletely obstructed in the course of a very few minutes. 
During an inquiry conducted by the Ventilation Com- 
mittee of the House of Commons I was allowed to make 
experimental alterations in the system of the ventilation 
in one part of the Chamber. Closing up the floor inlets 
there, I introduced air at the Gallery level. Under these 
conditions my feet were warm, my head agreeably 
cooled by a slight and grateful movement of the air, and 
my nasal airway unobstructed. Changing to and fro 
from the part ventilated on the old system to that venti- 
lated by the new, my left nasal airway each time became 
obstructed by the old, opened by the new. 

It seems pretty certain, thus, that not only does 
inefficient ventilation make workers " heavy " and 
" stupid " — no matter how great the air space may 
be ; it also tends to induce the best conditions for 
the catching of colds and the propagation of infectious 


Meanwhile, the employer who values his own 
interests will see to it that the system in vogue in 
his shop or factory is adequate. He will discover 
for himself whether the air is kept reasonably dry, 
and whether it is made to circulate in such a way 
that a braced and vigorous attitude characterizes 
his workpeople. He will see to it also that the air 
is neither too hot nor too cold. Having assured 



himself on these points he will, if he is wise, call in 
expert assistance and have any alterations made 
which may be necessary to secure the ideals aimed 

The physical effects of such care will be increased 
working power, a greater freedom from epidemic 
disease, and a diminution in the number of accidents 
owing to the quickened wits of the workers. In 
addition, there will be a moral effect, the reflex of 
the evident interest taken in the health and well- 
being of the operatives. This moral effect cannot 
be over-estimated, especially at the present time. 

It was found that a week of breezeless foggy 
weather in Winnipeg in 1913 produced more bron- 
chitis, pneumonia, and colds than usually occur 
throughout the whole Manitoba winter. To some 
extent this may be due to the fact that people 
huddle closer together in cold, wet weather. It has 
been shown, for instance, that a zone within one 
metre of a consumptive patient " is particularly 
dangerous for guinea-pigs kept within cages and 
exposed to saliva-spray infection." Yet even here 
the danger is much increased *' when doors and 
windows are shut in winter." Again, in an Aus- 
traUan troopship three decks were well, the fourth 
badly ventilated. The incidence of infective pharyn- 
gitis and epidemic catarrh was ten times greater 
among the badly ventilated troops. In the case of 
Canadian troops camped in tents on SaUsbury Plain 
under extreme conditions of wet and discomfort, 
excellent health was observed. When these men 
were transferred into huts catarrhs and sore throats 


broke out and spread rapidly and there were even 
cases of " spotted " fever (cerebro -spinal menin- 

Infection, while, of course, it plays its part, is 
thus not the whole story so far as the spread of 
epidemics is concerned. The weather also plays a 
part. It is evident that the ventilation of a room 
or workshop determines to a very great extent 
the " weather " therein so far as the workers are 


This factory " weather " may be hot and damp 
and stuffy if the ventilation is bad. In that case the 
immediate effect — in addition to the dulness and 
lethargy produced — is a swelling of the mucous 
membrane of the nose and air passages. This swell- 
ing has recently attracted a good deal of attention 
and has been proved experimentally. The mucous 
membrane in the hot room or " shop " becomes con- 
gested and covered with thick secretion. It remains 
somewhat swollen even after the man or woman has 
gone out into the open air. 

Such a swollen turgid mucous membrane prob- 
ably suppUes the requisite breeding-ground for the 
germs of disease. And these germs are very likely 
indeed to be present in the hot, heavy air of an ill- 
ventilated apartment, especially if many individuals 
are at work. Dr. Hill writes : 

In crowded rooms infection takes place from mucous 
spray, sneezed, coughed, or spluttered out in speaking. 
The inhaled bacteria mil be caught by the swollen 
mucous membrane covered with thick secretion. In 
those who live out of doors, not only is the membrane 


kept taut, but the flow of arterial blood through it is 
rapid, for the inhaled air has to be warmed up and 
moisture rapidly evaporated from the membrane, so as 
to saturate this air at body temperature. Thus more 
lymph comes out into the membrane from the blood- 
vessels, and this contains protective substances. Offen- 
sive bacteria are either washed away or destroyed and 
thus kept out. On the other hand, a membrane covered 
with thick secretion and congested offers a medium more 
suitable for the bacteria to settle and grow on, for it is 
boggy and stagnant, not flooded with fresh lymph. . . . 

But not only is there preparation of the ground 
for infection from without, there is also preparation 
of it for infection from within. Most of us carry 
about the germs of pneumonia and sore throat, and 
are only protected against these diseases by the 
resistance of our own tissues. The first lines of 
defence suffice to hold up the enemy. He remains 
on the ground, but does not enter. When, however, 
the walls of defence are cast down by the hot, ill- 
ventilated atmosphere, the scene undergoes a 
dramatic change. The germs begin to establish 
themselves, and disease results without any infection 
from other people. 

It has been suggested that the lymph poured out 
by the nasal mucous membrane, so-called " mucin," 
is probably the first line of anti-bacterial defence. 
In most acute influenzal throat affections the mucous 
membrane is red and dry, and the mucin fluid is 
absent. It has been shown, too, that the mucin can 
inactivate certain germs, notably that of poliomyel- 
itis. It is consequently to be expected that if much 



mucin is present infection will be less likely, if little 
is present it will be more likely. 

This idea receives striking illustration from the 
fact that employees who are exposed to certain mild 
irritants in the course of their work tend to keep free 
of colds. Dr. Hill quotes the case of the London 
Electric Railway Company, which reported that in 
the great influenza epidemic of 1918 only 3 per cent 
of their employees who worked in rooms ventilated 
by ozonized air were absent from the disease. Ten 
per cent were absent from rooms not so ventilated. 
Ozone is a mild irritant, and excites a flow of nasal 
mucin. Workers in sulphurous acid factories are 
said to be remarkably free from colds and influenza, 
and the same thing applies to workers in explosive 
factories who breathe nitrogen-peroxide and nitric - 
acid fumes. 

The evidence collected by Dr. Shufflebotham from 
poison-gas factories shows that workers in gases which 
irritate the nasal membrane are relatively very free from 
influenza, the few infected do not seem to have secondary 
symptoms. . . . Chemical manufacturers have a low 
phthisis mortality. 

It is not, of course, possible for employers to use 
irritants to aid ventilation, but it is possible for them 
to see that the stimulation of cool, dry air is present 
in their works. This cool, dry air acts on the nasal 
mucous membrane to stimulate it. A flow of mucin 
is encouraged and the germs of disease are killed or 
kept at bay. 

Lest there be any further doubt of this, experi- 


mental work was carried out to determine the effect 
of various atmospheres and various occupations on 
the resisting power of the nose and throat. In the 
majority of persons increased sweUing and redness 
follow exposure to heat, and the reverse occurs in 
cold. The nasal airway is thus blocked in hot and 
opened in cold states. If a fan be used, however, 
so as to blow air on the face the effect of the 
hot room is much modified. Moist heat produces 
greater changes than dry heat. 

The New York Commission on ventilation investi- 
gated this matter and reached the conclusions which 
we have just enunciated. They reported that of the 
persons examined by them representing all kinds of 
work " about 3 per cent of the students had chronic 
diseases of the nasal passages, 19 per cent of the 
outdoor workers, 35 per cent of the furnace-men, and 
46 per cent of the laundry-men." 

It is thus evident that the employer who fails to 
consider the ventilation of his factory or shop is not 
only losing output because of the soporific effect on 
his workers, he is also running a risk of epidemic 
disease which will place his hands on the sick list 
and so unhinge his business. If an epidemic comes 
he will be the first to suffer and will suffer more 
severely than his neighbours. Further, he may find 
epidemics actually beginning on his premises. 

We come back, then, to the need of scientific 
ventilation, not as means of satisfying some inspector 
whose ideas may or may not be modern, but as 
a means of increasing output, conserving business, 
and augmenting profit. The wise employer will not 


tolerate makeshifts in this respect ; he will insist 
upon having a really reliable system, a system 
approved by those competent to judge. 

America in this respect is leading the way, and 
indeed every week some new indication of the im- 
portance attached to these problems on the other 
side of the Atlantic comes to hand. In the Bulletin 
of the United. States Labour Statistics, No. 250, it has 
just been laid down that different trades must face 
their own special health questions and devise special 

These methods [it is said] include work along the 
lines of preventive and curative medicine and surgery, 
the safeguarding of the health of all the employees 
through the physical examination upon entrance, the 
relief from the strain of especially monotonous and 
fatiguing operations through the granting of rest periods 
or change of occupation. 

Many firms in America have abeady evolved 
systems of treatment and prevention on their own 
account. A total of 375 estabhshments reporting 
to the Government, employing over a milUon men 
and women, have, according to the last issue of 
The Medical World, accounted for 265 hospitals, 
while 110 offer first-aid equipment, 171 report their 
own physician, 181 their own nurse, and 131 first-aid 
attendants. The significance of these figures is 
enhanced by an appreciation of the need of pre- 
ventive measures such as ventilation, lightmg, and 
so on The statistics of treatment given show that 
261 estabUshments employing 770,000 men treated. 


on an average, 196,772 per month. In other words, 
24 per cent of males and some 27 per cent of females 
were afforded treatment. 

The importance of this is reaUzed when it is re- 
membered that an untreated case of, say, sore throat 
in a badly-ventilated room may end by placing half 
the effectives of that room hors de combat. Treat- 
ment removes the source of infection ; ventilation 
keeps the hnes of defence in good condition. The 
epidemic is " nipped in the bud," or rather is not able 
to start growing at all. 

It is inconceivable that what our friends in 
America are so eager about should leave us unmoved. 
Our need of health and vigour is even greater than 
theirs, for we are working on a sadly reduced popula- 
tion and, moreover, on a population which has been 
victimized by many diseases. Our margin of safety 
in a health sense is low. We cannot afford to take 
any risks. We may use as an illustration of this 
the condition revealed by a survey of the tinplate 

The rolling of tinplates is a very heavy operation, 
which is conducted in five stages. The whole cycle 
of the five stages occupies about ninety-six minutes, 
when 46 bars of 29 lbs. each are rolled. There is 
never any break in the rolling process of more than 
a very few minutes' duration right through the 
working week— i.e. from 6 a.m. on Monday tiU 2 p.m. 
(or 12 noon) on Saturday. The workmen seldom 
pause more than four minutes between any of the 
stages, and there is no delay when the shifts change, 
as the " doubler " of one shift puts in the furnace 


the bars required by the succeeding shift, and the 
fresh men are all ready and waiting to take their 

The conditions of work are thus heavy ; they are 
also trying. The temperature of the air, for ex- 
ample, in the neighbourhood of the workers was 
found to be as high as 110° F., and it is stated that 
this figure affords but an inadequate idea of the heat 
experienced. There are radiations from the red-hot 
sheets of metal, there is the partly opened furnace, 
and there is the heavy manual work being carried 
on. ''The men," says the report, "stream with 
perspiration within a very few minutes of starting 
work, and they drink many pints of home-brewed 
ginger-beer, milk, cider, and water during their shift 
in order to quench their thirst." 

It is manifest, therefore, that in this industry 
there are great opportunities for the scientific 
ventilator. It was sought to find out just how 
valuable his services were likely to prove and what 
bearing they would probably have upon the recorded 
output of the factory. 

The first point, and a very interesting one it is, 
which was noted was that the millmen's output 
actually varies with the atmospheric temperature, 
and is distinctly smaller in summer than in winter. 
This can be seen from the following table, which is 
an abridged form of Table VI. of the report : 



Relative Hourly Output per Mill at Factory B 


Average no. of boxes of i»lates 

durins veara 1912, l«>i:5, 1914, 

1915, 1916, 1917, and 1918. 

Mean external 

Dcg. >ahr. 

January . 












May . 






July . 









October . 









The ventilation of Factory B, to which the above 
table relates, is described as " about an average 
standard." Air from outside was driven along an 
overhead pipe from which branches opened about 
7 ft. above floor level. In this way air douches 
were deUvered between each furnace and pair of 
rolls, and, in addition, there was a pipe coming up 
from tlie floor and discharging air close to the waist 
of the roUerman. Each douche could be turned on 
and off at will, but a serious defect of the system 
was that the air current was not powerful enough 
to extend in any strength to the legs and lower part 
of the bodies of the men. The head and shoulders 
were thus liable to get too much cold air, and in con- 
sequence the men often turned off the current them- 
selves. In one factory they actually smashed the 
ventilating apparatus because of its inefficiency. 

Another factory where the ventilation was even 


better than at B was A. Fans and paddles were 
employed here. The bottom of the fan was about 
7 ft. from the floor, and there was a fan betxv^en 
each furnace. The draught was more marked than 
that occasioned by the other system. The seasonal 
variation of output resembled that of Factory B. 

A third factory, Factory E, had no artihcial 
ventilation whatever. The miUhouses, moreover, 
were situated in rather a confined space. There 
was much more seasonal variation in output than 
at Factories A and B, as is shown by the following 
table : 


April . 
May . 
June . 
July . 
October . 

Average number of boxes of plates during 
years 1913, 1914, 1916. 













Thus in January, the mean figures show, the out- 
put was no less than 9 per cent above the average 
for the year (100), while in August it feU to 9 per 
cent below the average. The seasonal variation was 
three or four times greater than at Factory A. in 
Fig 12 is shown graphically the efEect of the seasons 
on output-output and temperature being displayed 


by lines which, it will be observed, run almost 

In Fig. 13 is shown the seasonal variations at 
Factories A, B, C, D, and E. We have ab-eady dis- 
cussed A, B, and E. In C the ventilation was 
moderate. In D there was no ventilation at all. 
It will be seen from the curves that lack of efficient 
ventilation occasioned a great falhng off of output 
during the hot months of each year. 

Jan. Mar. Ma> July Sep. Nov. Jan. 
Fio. 12. 

The following table still further illustrates the 
point : 


Ventilation (artificial). 





July <fe 


Percentage reduc- 
tion in summer. 



Moderately good 
Moderately (or none) . 
None (but good natural) 
None (but poor natural) 








The loss in un ventilated factories is thus con- 
siderable, even when these rather rough figures are 
considered. It is stated that : 

It may be concluded that the output observed even 
in the coldest months of the year falls considerably short 



f— I 


•qodqno 0Afqe|3y 


of what might be attained with a perfect ventilation 

Reasons are given for supposing that efficient 
ventilation installed in an unventilated mill might 
increase the annual output of that mill by 12 per 
cent, though this is only an approximation. A really 
efficient system should combine the " plenum " or 
air pipe method with the use of fans and paddles. 
Fresh air should be driven into the building by 
mechanical means. It should be discharged at a 
suitable height above the floor level, and then dis- 
tributed to the men below by means of paddles. 
Moreover, mechanical arrangements should be in- 
stalled whereby the speed of revolution of the fans 
could be changed at will. In Factory A, for example, 
the fans always revolved at a rapid speed from 
March till October, when they were stopped for the 

Again, it is urged that the rate of revolution of 
the fans ought not to be constant, but rhythmical, 
or gradually waxing to a maximum speed, waning 
to a minimum, and then waxing again. Such 
rhythmic ventilation is more pleasant and efficient 
than steady ventilation, for the air currents are 
distributed better. The extra expense of such 
elaborate ventilation would be more than compen- 
sated for by an increased productive power of the 
men. It is added : 

In many American tinplate works cold air is driven 
up from the floor of the millhouses, but a workman 
who had experienced this system told me that it was 


much less pleasant than the EngUsh system, as it pro- 
duced chronic irritation of the skin of the legs. Agam, 
in some American works the mill floor is cooled by 
running cold water through pipes inserted in the floor- 
plates, and this method is said to be very efiicient m 
keeping the millhouse cool. 

Secondly, it is suggested that changes should be 
introduced in the clothing of the workers. It must 
never be forgotten in deaUng with the question of 
ventilation that the skin plays an enormous part in 
maintaining working efficiency. It is upon the skin 
that the currents of cool air play ; it is in the 
" radiator " formed by the skin that the blood of 
the worker is cooled and his temperature regulated ; 
the sldn is itself a delicate physiological mechanism 
so constructed as to be able to transmit stimuU from 
the outside world to brain and other organs. The 
importance of allowing a free circulation of air about 
the skin is thus manifest. Indeed, it is an essential 
factor in ventilation. At the present moment, 
before starting work, the men put on a short loose 
flannel shirt ending at the waist and open at the 
neck, and they thus help to keep the upper portions 
of their bodies cool; but throughout the "shift" 
they wear the same trousers and pants in which 
they came to the works, and these garments are 
generally "thick and woollen." Thus the lower 
part of the body, the part exposed to the red-hot 
sheets of steel, is kept very warm, and is unable to 
benefit from the ventilation currents of air. 

It is urged that the men should put on grey flannel 
trousers without pants : "for their underclothing 



must become saturated with perspiration, and though 
they generally change it when they get home, there 
is necessarily a delay of some minutes during which 
they may get chilled and acquire rheumatism." 
Tinplate workers are especially liable to this disease, 
the figure given by Collis and Hilditch, who investi- 
gated the subject, being " two to five times " more 
liable to rheumatism, rheumatic fever, and neuralgia 
than workers such as brass casters, grinders, and 

Another point the ventilating engineer must 
bear in mind is the humidity of the air. This, 
as we have seen, is a matter of vital importance 
because cooling depends to so great an extent 
on evaporation. It was found experimentally at 
Factory B that the output remained constant so long 
as the average humidity of the air did not exceed 
79 per cent saturation. Output fell 3 per cent when 
the air was 80 per cent or more saturated. At 
Factory D the effect of humidity was nil until the 
air was 85 per cent or more saturated, when the 
output was reduced 3 to 4 per cent. At Factory C 
humidity did not affect output at all. 

These small effects of humidity are clearly due 
to the fact that the industry is carried on at very 
high temperatures. Such temperatures lower the 
relative humidity of the air enormously — for in- 
stance, air completely saturated with moisture at 
60° F. becomes about half saturated when heated 
up to 80° F., and a third saturated when heated to 
90° F. Hence the millmen can never be workingTin 
air of more than moderate humidity. 



It is an interesting fact that at the same time as 
these findings were being arrived at another body, 
a committee of the Institute of Mining Engineers, 
was in process of reaching some very striking new 
illustrations of the meaning and value of ventilation. 
This committee carried out a research into the 
atmospheric conditions in deep and hot mines. It 
found that the control of temperatures in deep mines 
was dependent on adequate ventilation. The Coal 
Industry Commission recently placed the absolute 
limit of depth at which mining could safely be carried 
out at 4000 feet ; but one conclusion which has 
already emerged from the researches which are now 
proceeding " is that under the ordinary means of 
ventilation mining can be carried on at 5000 feet, 
and would, if these methods were extended by 
artificial means, be practicable at an even greater 



With the ending of the war has come a renewed 
determination on the part of all classes of men to 
rid our civihzation of the plagues which continually 
threaten it. The war against disease has been 
declared anew, and every citizen is called upon to 
play his part so that life may be rendered not only 
safer but more productive and more useful. 

Not the least of the great enemies who must be 
conquered is tuberculosis, the " White Plague," that 
subtle foe which lies in wait for all, and which by 
slow stages brings the strongest and the best to ruin 
and death. In its varied forms it is responsible 
for one-ninth of the total death-rate of the United 
Kingdom. It claims a total of over 50,000 victims 
in England and Wales each year. In our industrial 
districts, especially where the workers of the land 
live, it is so rife that, according to Dr. Thomas E. 
Nuttall, in the administrative county of Lancaster, 
with a population of about If milUon, there are over 
2000 deaths annually from tuberculosis. 

But death is only a small part of the bitter toll of 



this scourge. In Great Britain tubercle of the lung, 
*' consumption," holds at least 150,000 persons in a 
state of disablement during those very years which 
should be the most industrially productive. More- 
over, according to a conservative estimate, there are 
in perpetuity in this country 500,000 persons who 
have sustained infection by the disease, although they 
are not at the moment disabled so that they cannot 
work. In the year 1918 no fewer than 92,000 fresh 
cases of the disease were notified, and this represents 
but a proportion of the total number of cases arising. 
We may set this dreadful disaster down in tabular 
form thus : 

Per Annum — England and Wales 

Deaths 50,000 

New cases 92,000 

Cases disabled 150,000 

Cases infected but not disabled . 500,000 

Total .... 792,000 

It is thus manifest, as we have already suggested, 
that practically every industry in the country must 
contain tuberculous employees and that consequently 
the chance of contracting this disease in industrial 
life where men and women work for long periods in 
close contact must be very high indeed. If the 
plague is to be fought it must be fought not only in 
the home, but also in the factory and the workshop, 
and employers must see to it that the plans made 
for the health of their workpeople take this disease 
into account and set up barriers of the strongest kind 
against its propagation. 

i •"' 




It should be understood in the first place that 
unless the disease is discovered in its early stages, 
little or nothing can be done. The victim, long 
before the true nature of his malady is recognized, 
may be somng seeds of death among his fellow- 
workers. He may be carrying home with him 
infection which will presently break out among his 
children. He may even be a source of danger to 
his employer, should he come into personal contact 

with him. 

For tliis reason, medical examination of em- 
ployees at regular intervals is of the first importance. 
In dusty trades, as we have already pointed out, it 
is absolutely vital. The inspecting doctor must 
carefully investigate all symptoms, and must be in a 
position, if need be or if he has any doubt, to have 
the patient's expectoration examined for tubercle 
bacilH. He should also be able to send the patient 
for X-ray examination. 

Even with these precautions, early cases will 
occasionally be missed, for unhappily tubercle bacilli 
do not, as a rule, appear in the lungs until the disease 
is well estabhshed. 

Repeated examination will, however, minimize 
the danger of missing an early case, because symp- 
toms that might not arouse suspicion on a single 
occasion will become important when they are found 
to have persisted over a period. This, of course, 
means that the medical officer to the factory will 
keep accurate records of his examinations of the 
workpeople and of their symptoms. 

It cannot be too clearly understood that con- 



sumption is a disease which the powers of the body 
are well able to cope with so long as these powers 
are unimpaired. At post-mortem examinations it is 
exceedingly common to find old, healed tubercular 
scars, showing that the patient, during his Ufe, threw 
off the disease and overcame it. A short period of 
rest, a Uberal diet, a visit to the country, are often 
sufficient means to turn the scale against the disease. 
It is often urged that to demand of employers so 
great a care of their workpeople is unreasonable. 
We have frequently controverted the idea, for it is 
a fact that employers who have instituted medical 
inspection invariably speak in warm terms of the 
advantages gained by this step. An American 
writer. Dr. Mock, has recently coUected statistics 
from ten large industries in which very exceUent 
medical staffs are retained, and his conclusions are 
worth the most careful consideration. He presented 
the following table in the Journal of Industrial 
Hygiene : 

1. Total number of applicants ex- 

amined in the year . . • 

2. Total number employed having 

disabilities that did not inter- 
fere with selected work . 

3. Total number rejected for work 

because of disabilities 

4. Total number having no disabili- 

ties of any moment . 

5. Total number of regular employees 

Dr. Mock declared : 


41,158 (34-7%) 


66,309 (55-6%) 

It is fair to assume that these 11,433 applicants who 
were rejected for work would have soon lost their posi- 


tions because of inefficiency, or would have left because 
of sickness. Certainly by the end of a year practically 
all of these would have been eliminated from the working 

The loss must have been great from decreasing 
efficiency due to disease, from increased accident 
rate, from loss of time due to sickness, and the re- 
sulting sick benefits. One authority has estimated 
the cost of living and training per individual at $35. 
If that be accepted the 11,433 rejects would have 
cost the companies concerned, had they been em- 
ployed, $400,155. A more recent estimate places 
the cost of living and training at $45. If the medical 
work be taken as costing $2-50, we get the following 
balance-sheet : 


1. Saving to ten concerns from rejection 

of physically unfit 400,156 

2. Cost of entire medical work in these 

concerns 256,000 

3. Profit to the concerns from this one 

branch of medical work .... 144,165 

In addition, the fact that slightly disabled em- 
ployees were placed in work suitable to them, and 
so saved from breakdown, adds about $144,000 to 
the employers' profit. These figures refer to all 
diseases. The case of tuberculosis forms an excellent 
illustration of what they mean. For not only does 
this disease incapacitate its individual victim, it 
spreads with great facility and so gains other victims. 
Thus there is loss of a widespread character, much of 
which, represented by acquired skill and dexterity, 
is quite incalculable. 



It is, of course, a truism that the tuberculous 
problem' is closely alUed to the problem of housing. 
This, again, touches the problem of transport, for so 
long as workers are crowded together in areas 
suitable only for factories, so long wiU this disease 
spread among them. Here is to be found the 
justification for those industrial cities upon which 
certain of the great employers of labour have 
expended so much care and energy. Movements are 
now on foot to encourage smaller employers to com- 
bine together and become the landlords of their own 
workpeople, by acquiring suitable sites and erecting 
houses of good and sound construction. This work 
is stiU in its infancy, but undoubtedly there is a 
great future before it. An employee who comes 
from a clean and wholesome house, where his meals 
can be properly prepared, and where his leisure can 
be spent advantageously, is manifestly a much 
better investment than one whose home is situated 
in a slum, whose food is ill-cooked and worse served, 
and whose leisure belongs for the most part to the 
local pubUc-house. No attempt, so far as we know, 
has been made to prepare a balance-sheet of profit 
and loss based on a comparison between the two 
types of home environment. But experience would 
suggest that, original outlay notwithstanding, the 
landlord employer of the type referred to makes a 
handsome profit on his foresight and pubfic spint. 

Another potent enemy of tuberculosis is regular 
exercise. This subject has received a great deal of 
attention lately, since, indeed, it was found that 
weedy and " unUkely " young men from our m- 



dustrial areas became strong and well-developed 
under military training. The result of this know- 
ledge has been a demand for physical education on 
a national basis. As usual, the more enlightened 
employers have seized upon the possibiUties offered 
and instituted courses of instruction in their works. 
It is too early as yet to assess the results in terms of, 
e.g., a falHng consumption rate. But evidence is not 
wanting that such a declension is, in point of fact, 
a consequence of the movement. Physical educa- 
tion does not, of course, destroy the tubercle bacillus, 
but it raises the resistance of the man to infection. 
It makes the " soil," if that term may be used, 
unproductive. The germ cannot flourish there and 
tends to die out should it gain a lodgment. 

Among the friends of the tubercle bacillus, if we 
pass over dirty, ill-constructed homes, are lack of 
sunlight, alcohol, and venereal disease. The first 
deserves close and careful attention. Very many 
factories and workshops are ill-Ut, dingy, and damp. 
The windows are so placed that direct sunUght never 
penetrates to the interior. As a result, the remark- 
able germ-kilHng power of sunlight is entirely lost 
and the spread of every kind of disease facihtated. 
This is a matter which can be set right in most cases 
with great ease, or at least with but httle real 
difficulty. A recent experiment, where the lighting 
of a workroom was altered so that the sun was able 
to shine into it, resulted in an immediate fall in the 
number of cases of coughs and colds and a general 
improvement in health. The workers, who had 
tended to be pale or sallow in complexion, were 


found to keep a better colour and to be more cheer- 
ful. Their work improved in quafity ; moreover, 
their resistance to disease, and this appHes especially 
to lung disease, increased. Coughs and colds, 
anemia, dyspepsia, and so on are common pre- 
cursors of tuberculosis. 

Alcohol, when abused, is a potent reducer of 
resistance. By means of it the " tone " of the whole 
body is lowered, the individual cells become flabby 
and inactive, and the seeds of disease grow without 
difficulty. The public-house of the wrong type and 
the slum are old associates. The cheerless home 
serves as the incentive. The result is loss to em- 
ployer and employed, and a richer harvest for all the 
deadliest diseases. 





There is another affliction which, though less 
spoken of than tuberculosis, is not less deadly in its 
work nor less costly in its effects — syphilis. 

The subject has been dealt with by many 
authorities, but so far its industrial aspect has been 
largely overlooked. Yet there can be no doubt, as 
is stated by Dr. Oliver in the Journal of Industrial 
Hygiene, that it " causes a sufficient decrease in the 
efficiency of the working world to rank it as one of 
the most important economic problems in industry." 

Little or no attention was devoted to this disease 
by the British committee on the health of munition 
workers. The times, it is true, were serious and the 
need of haste was great. Yet venereal disease was 
increasing very rapidly all over the country, and 
steps might have been taken to consider its relation 
to industry. Unhappily, as Dr. OUver points out, 
sjrphihs has until recently been largely taboo as a 
subject of discussion, both here and in the United 
States, so that we have even yet only a slender 
knowledge of the prevalence and extent of the 




disease. A false sense of modesty prevents due 
publicity being given to its depredations. 

The city of New York has during the past few 
years made venereal diseases notifiable. In the 
fourteen weeks from July 4 to October 3, 1914, 
25,633 cases of all infectious diseases were returned. 
Of this list syphilis was head with 6432 cases, or 
28 per cent of the whole. Tuberculosis came 
second— 5525 cases, or 21 per cent ; diphtheria 
third, measles fourth, and scarlet fever fifth. It is 
obvious that a case of diphtheria or of scarlet fever 
is much more likely to be reported than a case of 
syphilis— for in connexion with this latter disease 
secrecy is so very often the policy pursued. Conse- 
quently, it is probable that Dr. Oliver is not making 
an over-estimation when he thinks that only about 
50 per cent of the total infections by syphiUs were 
ever brought to light. It is certainly the case that 
a disease which is so extensive must form a serious 
cause of industrial inefficiency. 

The American Army has furnished some other 
statistics wliich are worth quoting. Thus, during 
the fifty-three weeks ending September 27, 1918, 
there were reported 178,204 cases of venereal 
disease. About 16 per cent, or 27,000, were cases 
of syphilis, the remainder being gonorrhoea. During 
1917, 750,000 days were lost to the Army through 
venereal disease. In 1918- things were very much 
worse, the loss reaching what is described as the 
'' alarming total of 2,067,000 days." 

The most momentous fact in connexion with 
these latter figures is that no fewer than 85 per cent 


' £ < 


of the cases had become infected with syphilis 
before they entered the Service. This gives point 
to Colonel Vedder's statement that " 20 per cent 
of the young adult population " (of America) '' from 
which the Army is recruited in peace time are 
luetic " (syphiUtic), " and 5 per cent of our young 
men in college are infected. Since syphihtic infec- 
tion is so common and so productive of disabihty, 
and has so far evaded sanitary control, it is beheved 
that syphiHs is a greater menace to the public health 
than any other single infectious disease, not even 
excepting tuberculosis." Osier puts syphilis third 
or fourth among the killing diseases, and estimates 
the actual deaths annually at 60,000, " which makes 
it rank first among infections." Leredde estimates 
that it kills 25,000 persons each year. 

Not only so, but syphiUs kills or disables the 
worker at the very time when his earning capacity 
should be at its best and when his skill should be of 
most value to his employer. This is one of the 
diseases which seem to play with their victims 
through youth and strike them down in early or 
late middle age. What doctor has not seen the 
man of 40 to 50 whose heart or blood-vessels are 
breaking down as the result of uncured syphilis. 
Most cases of aneurism owe their origin to this 
disease, and it is now practically certain, thanks to 
the researches of Sir Frederick Mott, that general 
paralysis of the insane is due to the same cause. 
Locomotor ataxy, aortic disease, cases of apoplexy, 
cases of insanity of various kinds, can often be 
traced to this scourge. Thus the infection, con- 



tracted it may be in early youth, strikes down the 
valuable worker at the very moment when he is 
reaping his harvest, robbing him of the fruit of his 
labour, and his master of services which are often 
only too difficult to replace. 

But the evil goes further even than this, for 
syphiUs seems to bring a tendency to other diseases. 
Thus, according to Dr. Oliver, some careful investi- 
gations have shown that between 20 and 30 per 
cent of tubercular patients also suffer from this 
disease. " Syphilis has been shown to be an im- 
portant predisposing factor in tuberculosis." Again, 
Sir William Arbuthnot Lane, the eminent surgeon, 
has recently declared that syphiUs ranks high, in his 
regard, among factors inducing to cancer. Another 
surgeon recently called attention to the frequency 
with which syphilis of the tongue was followed by 
cancer of that organ. From a study of figures 
obtained in an American general hospital it appears 
that between 20 and 30 per cent of the patients were 
infected with syphilis. 

Here, then, is a disease which most commonly 
begins in early life, which lies latent— we do not yet 
know how great a tax it is on the strength of the 
individual during this period— for years, and which 
may predispose to consumption and cancer. In 
most cases, if uncured, it breaks out in middle Ufe 
or earlier, producing some deadly affliction from 
which the victim gradually dies. It is dreadfully 
contagious, and destroys not only its immediate 
victims but their progeny. Industry has certainly 
no worse foe. The so-called " tertiary " syphihtic 



works great havoc. " They are the potential causes 
of accidents to themselves and to others. When 
injured their disabiHty is always prolonged. They 
are generally chronic absentees, inefficient employees, 
and a source of trouble at all times "—that is to say, 
those of them who are able to work at all after the 
late form of the disease has shown itself. The 
following case is cited from Dr. OHver : 

B. R., aged forty -four, a foreman in one of the busiest 
departments, became so inefficient in his work as to 
attract the attention of his manager and his fellow- 
employees as well. From a bright, active, energetic 
foreman he had suddenly changed to an absent-minded 
and careless workman. Important orders were for- 
gotten, and worry over his condition was evidently 
making things worse. 

Knowing that something was wrong his manager sent 
him to the doctor's office for a complete examination. 
Several months previously, while on his vacation, 
standing on his front porch one evening, without any 
warning, he fell over, became unconscious, and re- 
mained so for a short time. When he recovered con- 
sciousness he knew nothing of what had happened. 
After a few days' rest in bed he recovered and returned 
to work. The incident bothered him a little, but not 
to the extent it was destined to when he had several 
similar attacks. His family physician pronounced it 
" nervous exhaustion," but he did not improve under 
treatment. . . . 

He was told of his condition— by the works doctor— 
and then admitted having had an initial lesion twenty 
years previously, for which he had taken little or no 
treatment. Anti -syphilitic treatment was begun at 
once, and has been continued ever since. His health is 


very much improved, he has had no more attacks, and 
his work has returned to better than its previous 

We have given this case in full because it illus- 
trates exactly the miserable condition to which 
syphiUs in its late stages is able to reduce its victims 
and shows the heavy economic, loss occasioned by 
the disease. It should suffice to prove to every 
employer of industry that the campaign against 
venereal disease concerns him closely and that all 
the help he is Ukely to be able to afford that cam- 
paign will be money invested rather than money 

given away. 

The main platform in the campaign is necessarily 
education. If young men and women understood 
not only the moral aspect of the case, but also the 
dreadful danger they are running, there can be 
no doubt that the incidence of the disease would 
diminish. This is a great opportunity for the em- 
ployer of industry, because he has it in his power, if 
he likes, to distribute knowledge among his work- 
people either as printed leaflets prepared by a 
medical authority or by means of lectures given by 
a doctor. In the same way the promotion of 
healthy games among the workpeople will tend to 
minimize the danger. These methods are said to 
have been very helpful in the Army. 

The second means of prevention is what is known 
as prophylaxis after exposure. A controversy is 
raging at present on this subject, but all are agreed 
that the sooner a man cleanses himself after ex- 
posure to infection the less likely is he to contract 


the disease. Various preparations for " immediate 
self -disinfection " have been recommended. Dr. 
OUver writes : 

It is our duty to teach men that once they are exposed, 
prophylaxis does protect in the great majority of cases 
if taken immediately after or within six hours of ex- 
posure — the quicker the better. . . . 

In the (American) Army of 23,702 men taking 
prophylaxis over a period of twenty-two weeks only 1 
per cent developed a venereal disease, although many 
did not apply for many hours after ex:posure. 

The employer might well consult with his doctor 
and obtain the consent of the local authority to 
placing means of prophylaxis at the disposal of his 
workpeople. It is but fair to add, however, that in 
doing this he would encounter opposition from those 
who regard such a step as morally indefensible. 

Medical examination of entrants should, of 
course, be carried out, and if syphilis is discovered 
it should be treated. If it occurs in the works it 
should also be treated at once. Dr. Blaisdell, of 
Boston, selected 60 cases that came to him, and 
found that between the time of their infection and 
the time of their first appearance for treatment these 
cases had " exposed 134 other individuals " directly, 
and had endangered 422 through family life and 651 
by occupational association — in all 1227 people. 
Thorough treatment at the earliest moment and 
segregation are thus necessary. The Medical Re- 
search Committee has recently issued a report 
showing that when very early treatment — by 


Salvarsan— is given the disease does not tend to 


This disease alone illustrates the vital importance 
of the doctor in industry. In fact, it makes it 
abundantly certain that the time has arrived when 
the doctor must take his place as the indispensable 
helper of both employer and employed. 


pW '!^ 



It was found during the war that the number of eye 
injuries increased very much. This was more especi- 
ally true in relation to such injuries as " strain," and 
was ascribed to the fact that the work in munition 
factories often demanded a high degree of visual 
acuity. Moreover, the Ughting was often very 

These eye-strains made up a heavy total of dis- 
abiUty, and so affected to an important degree the 
bulk of output. Nor was this immediate loss their 
worst feature. Some of the injuries inflicted are 
still operative and are still costing industry a heavy 
toll. It is for this reason that attention is now 
being directed to the question of lighting in factories, 
and also to the necessity for examination of the eyes 
before certain kinds of work are undertaken. We 
have referred to this movement in a general way 
when considering the relation of eye defects to street 
accidents, and also the question of eye disease in 

The evidence of increased loss during the war 




came from every area. The out-patient book at the 
Ophthalmic Department of the Glasgow Royal 
Infirmary showed that the number of those suffering 
from " fires " and other trivial eye troubles who 
applied for relief during August 1916 was "more 
than double the number who had come suffering 
from similar injuries during the corresponding month 
in previous years." A report from Coventry put 
the time lost from eye injuries at 2000 days' work in 
this town alone. 

Industrial work may cause impairment of eye- 
sight in several ways. The eyes may be injured by 
exposure to intense heat or to poisons, they may be 
struck by flying particles, they may be " strained " 
as a result of uncorrected errors of refraction or as 
the consequence of bad Ughting. 

As regards accidents, it may be said generally 
that these represent some 5 per cent of all industrial 
accidents. Most of them are trivial, yet even the 
trivial ones cost the employer time and money, for 
as a rule they represent from a half to a whole day 
lost. Moreover, to the initial damage must be 
added the danger of infection and a subsequent 
suppurative process. On this head a surgeon has 
written : 

If the injury be neglected, or if it be treated by any 
one who is unskilful or careless, sepsis will almost 
certainly occur ; and all experience teaches that infection 
of the wound is a far greater danger than the actual 
physical damage to the ocular structures. The occur- 
rence of sepsis at once transforms a very trivial injury 
to the cornea into a suppurative keratitis which may 




run a prolonged course, lead to more or less impairment 
of sight, and in serious cases even destroy the eye. 

This danger is real and serves as another argument 
in favour of good first-aid work in every factory and 

Eye-strain is more insidious than accidental 
injury ; it is also much more crippling. It may be 
accentuated by age, fatigue, or unsatisfactory health 
of the worker, by near distance work, insufficient or 
excessive illumination, abnormal position, or long 
hours. During the war evidence was collected on 
this subject, and embodied in a special report. 
According to this eye-strain and headache followed : 

(a) Inadequate light, both artificial and natural. 

(6) Artificial lights, adequate in amount but so placed 
as to throw a glare upon the eyes of the workers. 

(c) Employment of workers (whose eyesight should 
be aided by suitable glasses) to carry out fine work 
without first testing their eyesight. 

The condition, again, may be but one manifesta- 
tion of a general fatigue. It is thus more likely 
to occur when long hours are worked, when night 
shifts are necessary, or when workers are ill-cared 
for, under-nourished, anaemic, or of poor general 

An inquiry made into the eyesight of 156 workers 
in a factory producing munitions of war showed that 
most of the eye defects were found in the fuse 
department, where fine processes were in operation, 
involving close attention. In the work of making 


shells only about 19 per cent of eye defects were 
noted, but in the fuse department the proportion 
reached 64 per cent. The report of this inquiry 
states : 

In the fuse department 8 per cent of the workers were 
obliged to obtain glasses since starting factory work, 
19 per cent complained of eye-strain, of whom 12 per 
cent found sight difficult in the night-shift, and 2 per 
cent found the eye -strain increasing in severity. Besides 
these, 10 per cent appeared to have latent eye-strain, as 
shown by severe headache, blepharitis, etc., and prob- 
ably required to have their eyes tested. Conjunctivitis 
was present in 11 per cent. Many workers complained 
of the artificial light falling directly on their eyes, and 
others said that the reflection of the brass work of the 
fuses was dazzling. The artificial lighting in the factory 
was by electric lights placed over the benches. . . . 
On the other hand . . . several girls had been warned 
at school by the school medical officer that their sight 
was defective, and had neglected to obtain glasses. 
Five workers had obtained glasses but did not wear 

Eye-strain, then, is a powerful enemy of efficiency 
and of output, especially in those industries in which 
fine work has to be carried out. Consequently, its 
prevention is a matter of the greatest practical 
importance. The employer who consults his best 
interest will neglect no precaution to this end. 

There are certain general measures which have a 
bearing on preventing eye-strain. These may be 
grouped together as measures designed to improve 
the physical health of the workers — we have dealt 



fully with them in previous chapters. But, in addition, 
a number of special measures must be taken. Of 
these one of the most important is certainly the 
examination of eyesight by competent observers. 
In the first instance, the medical officer attached to 
the works or even the nurse or welfare supervisor 
may be able to apply some simple tests. In all cases 
in which abnormaUfy is discovered the patient must 
be referred to an ophthalmic surgeon or eye hospital 
for regular examination and, if necessary, glasses. 
When workers are to be examined for glasses the 
nature of the work they propose to carry out must 
be specified, since special and different glasses may 
be required for distant vision and for near work. 

Under certain conditions the eyes should be pro- 
tected by goggles. This is necessary when particles 
are Hkely to be driven against the worker. In 
acetylene welding the glass should be tinted or 
specially prepared to obscure the chemically active 
rays at or beyond the violet end of the spectrum — 
the so-called " ultra-violet rays," which possess a 
power of damaging Uving tissue. Dark blue glass 
has usually been employed, but there are objections 
to this. Dark " neutral smoked glass " is better. 
One authority recommends " a very deep rose tint." 

We have already dealt with the treatment of 
accidents to the eye by " first-aid " means. The 
question of Hghting, therefore, remains as the last, 
and most important, measure of help in this group 
of industrial affections. 

The Factory and Workshop Act does not, curi- 
ously enough, contain any provision in regard to the 



Ughting of factories. The question has, however 
been dealt with in a report of the ^departmental 
Committee on Lighting in Factories and Workshops 
pubUshed in 1915. The essentials of good hghtmg 
are thus summarized : 

1. Adequacy. , ., .. 

2 A reasonable degree of constancy and uniformity 

of illumination over the necessary area of work _ 

3 The placing or shading of lamps so that the light 
from them does not fall directly on the eyes of an opera- 
tirwhen engaged on his work or when lookmg hori- 
zontally across the workroom. 

4. The placing of light so as to avoid the castmg of 
extraneous shadows on the work. 

The principal effects of good lighting were sum- 
marized by an expert witness, and his conclusions 
deserve the most careful attention. The quabty of 
work, he declared, and of output suffer if the illumina- 
tion is inadequate, particularly in the case of 
the delicate operations often called for. Adequate 
iUumination on the other hand assists the super- 
vision of workers, with the result that carelessness 
and errors on the part of newly-trained employees 
is more readily detected, and instances in which a 
worker requires a rest are noticed more speedily 

Inadequate illumination by adding to the diffi- 
culties of skilled labour increases the nervous stram 
on the operators and reacts on their physical condi- 
tion the risk of accident is increased and machines 
become more liable-through insufficient care-to 
break down. Further, it is generally recogmzed that 


operators work more cheerfully in well-lighted rooms. 
Bad Ughting depresses their spirits and lowers their 

Natural hghting is always to be preferred to 
artificial on grounds of health as well as on grounds 
of economy. Roof hghting is superior to side 
lighting, especially if it can be arranged that the 
light enters the shop from the north. In a good 
system of roof lighting the light is " uniform." 

Again, much can be done to make the Ught 
effective by painting the walls of the room in light 
colours and keeping the ceihngs clean. This, too, 
affords an effective background for dark objects. 

Moreover, the natural light can be aided in several 
ways : 

By deflecting vertical light into the room by means 
of reflectors or prismatic glass or by whitening the 
surface of an external wall or building which obstructs 
the light. 

The position of permanent working points should 
be so arranged that adequate light will be available 
for each. Efforts, too, should be made to see that 
the supply of hght is not cut off by dirty windows or 
other removable cause. All windows must be so 
constructed that they can be cleaned easily. 

In the use of artificial hght, glare must be avoided 
so far as possible. The light must be as steady as 
possible and shadows must not be cast upon the 
work. Gas has its advantages, but it should not be 
forgotten that each cubic foot of gas pollutes the 
atmosphere to the same degree as one adult person. 



The best form of gas illuminant is, of course, the 
incandescent-mantle burner, properly ventilated. 
Both gas and oil give off heat, water vapour, and 
carbon dioxide gas, and these, in bulk, may exercise 
a deleterious effect on output. In this respect 
electricity is easily the most hygienic of illuminants : 
no oxygen is used up, no carbon dioxide gas and no 
moisture are produced. 

Another form of eye trouble in industry is 
Miners' BUndness. The subject was almost unex- 
plored until a very brilhant investigator, Dr. Lister 
Llewellyn, the first Tyndall Mining Research student 
of the Royal Society, essayed its elucidation. 
Before he began to work it had of course been well 
known that workers in deep mines tended to develop 
a condition of the eyes known as nystagmus and 
characterized by a curious lateral or side to side 
twitching. This condition as well as being exceed- 
ingly unsightly led in many cases to bUndness, and 
was therefore regarded with great anxiety by the 
men employed in those mines. 

Dr. Llewellyn returned to his subject at a meet- 
ing of the North Staffordshire Institute of IVIining 
Engineers. Miners' nystagmus, he declared, was an 
occupational disease of the nervous system found 
only any)ng workers in coalmines. The first symp- 
tom was failure of sight, especially at night time or 
when the sufferer was called upon to perform the 
more skilled portions of his work. The man then 
complained that the lamps dazzled his eyes, and, 
sooner or later, that the lamps and all surrounding 
objects danced before him. 



In addition to these symptoms there is headache, 
varying from sHght pain between the temples to 
attacks of extreme severity, giddiness on exertion or 
stooping, inabiUty to see at night time, and dread of 
lisht. In fact, the man is reduced to a deplorable 
state of weakness in many instances. 

The economic aspect of the disease is not less 
depressing. Dr. Llewellyn estimated that if a man 
were off work for a year the loss to the country would 
be at least £359, made up of £65 compensation and 
£294 loss of coal output (235 tons at 25s. a ton, 
pithead price). He calculated that since 1913 there 
had been at least 6000 men disabled each year from 
nystagmus. If it were assumed that each case 
" played " six months in the year the total direct 
cost to the country would be 3000 times £359, or 
over a milUon pounds a year. This meant a loss of 
nearly three-quarters of a million tons of coal a year, 
and a cost of one penny per ton on coal. 

We may figure this bill of loss as follows : 

Loss in man -power, 6000 per year. 

Loss in money, at least £1,000,000 per year. 

Loss in coal, 750,000 tons per year. 

Loss in cost of coal. Id. per ton added. 

In addition, we must take account of the accidents, 
both small and great, which occur as the result of 
this dazzUng and blindness. Dr. Llewellyn said : 

There is always the possibility that a catastrophe 
may result from the failure of a fireman or collier suffer- 
ing from the disease to detect the presence of gas. I 
have examined 41 nystagmus cases for the detection of 


the firedamp "cap" on the safety lamp. Only 4 
detected it correctly and 16 failed to see the " cap. 

One might suppose that a disease at once so 
ruinous to health and so costly would have been 
attacked by every weapon available. The average 
reader wiU therefore be surprised to learn that 
miners' nystagmus is not only a preventable disease, 
but is actually a disease the prevention of which has 
been worked out and understood. 

It was found, for example, that in certain mines 
which are Ughted by dayUght nystagmus did not 
tend to occur. In other mines in which the iUumma- 
tion was very good the incidence of the disease was 
low, whereas in deep and badly -illuminated mines 
the number of cases tended to be highest. The 
natural inference, in the first instance, was that 
lighting had something to do with onset. 

Further work only tended to confirm this early 
impression. The miner in the badly-Ht mine had 
his sight continually intrigued by a point of light, 
and so a movement or pull of the ocular muscles took 
place which was the first-fruit of the mischief. 

It may be said then that deficiency of illumina- 
tion is the dominating factor in the causation of this 
disease. In the opinion of the investigator who first 
drew attention to the matter, Dr. Llewellyn, it is 
" so important that all other factors become insigm- 
ficant." Thus the problem of prevention is nothing 
more nor less than the problem of lighting. Certain 
factors, however, must be taken into consideration : 

1. Nystagmus is a disease of gradual onset, and the 


average number of years of underground life before 
failure of sight has been found to be twenty-five. 

2. The illumination in open-light pits is five times 
that in safety-light pits. 

3. Cases of nystagmus, although uncommon, do occur 
in naked-light pits. 

It is thus evident that at any given time in our 
ill-lit pits a certain number of cases of this disease 
will always be maturing. This factor should be 
borne in mind. If it is overlooked, an owner who 
does his duty and installs a proper lighting system 
may suffer keen disappointment when cases of 
nystagmus continue to occur. He will be apt to 
jump to the conclusion that after all lighting was 
not the real cause of the disease, and that his effort 
has been wasted. The moment it is realized that 
these " new cases " are, in fact, old cases, the result 
of the old bad system and not the new good one, the 
owner will discount them. 

The full benefit of any measures taken will, 
therefore, not be effective for some years. They 
will show their good effects more tardily, of course, 
and to a less degree, if they are inadequate. Thus 
it has been laid down that " the illumination in 
safety-light pits must be increased at least five-fold." 
Even then nystagmus will not be completely eradi- 
cated, for the sensitiveness of eyes varies within 
considerable limits. 

It is a lamentable fact that very little seems to 
have been done in this country to attack this great 
evil. The miners themselves are fully alive to their 
danger. At their conference at Keswick, in July 



of 1919, they demanded a special inquiry, and 
instructed their executive committee to make an 
investigation on its own behalf. It was declared 
that the disease was acting with "increasing fre- 
quency," and that an addition to the illuminating 
power of the miner's lamp was urgent. The electric 
light was satisfactory in that respect, but its present 
design made it useless for the detection of dangerous 

This difficulty has, we believe, been overcome to 
some extent, though it remains a difficulty. The 
Americans have certainly adopted a form of electric 
lamp which is so constructed that the miner carries 
a small battery to illuminate it on his person. This 
course is said to afford excellent results and to be 
free from danger. The home miners have, however, 
expressed some anxiety and it is a fact that the light 
is not much used. 

The value of the American light found a strong 
advocate in the columns of The Times in March 1920 
when Dr. J. S. Haldane, the eminent physiologist 
and authority, wrote that : 

From recent personal experience in American coal- 
mines I can speak strongly of the comfort and efficiency 
of the type of lamp which your correspondent refers to, 
and which has been thoroughly investigated by the 
scientific staff of the American Bureau of Mines. This 
lamp not only leaves a miner's hands free at all times, 
but enables him to get the source of light close up to 
what he is working at. The resulting great advantage 
depends upon the fact that the illumination varies 
inversely as the square of the distance of the lamp. 



Dr. Haldane went on to urge the importance of 
further research on this subject, declaring that in 
this and many other matters connected with mining 
the inadequacy of our provisions for research and 
the red tape of existing official regulations were 
delaying the trial of what appeared to be better 
methods. His views were echoed to a great extent 
by Dr. Llewellyn. He urged in the strongest terms 
that research work to discover a better illuminant 
for safety-Ught mines was essential. He suggested 
that the Mining Association of Great Britain and the 
Miners' Federation should each subscribe £50,000 to 
a research fund. He added : 

Coal is wanted everywhere, and when you improve 
the ilhimination of the coalmine you will not only 
.diminish the incidence of nystagmus and lessen the 
frequency of accident, but you will also increase the 
coal output. Nystagmus not only causes total disable- 
ment, but is also responsible for lessened production in 
men who have not yet failed. 

The mining industry certainly cannot afford to 
allow this blot to remain on its reputation. It 
should be encouraged to turn to research by the 
excellent results which have been achieved by the 
scientific method in another of its own departments. 

The matter, however, in the case of miners' 
nystagmus must be carried to a higher plane than 
mere profit. It is no less than a national crime that 
these men are being maimed at present. Were the 
disease not an old and tvell-estabUshed condition 
to which, unhappily, people, and especially the 


miners themselves, have become accustomed, the 
present state of affairs would give rise to a strong 
pubUc outcry. FamiUarity has bred indifference, and 
complacency is ready to talk of " risks incidental 
to the calUng." This is the wrong spirit ; it is a 
spirit unworthy of the great tradition of British 

^i I 





Some time ago the Monthly Report of the British 
Steel Smelters, IVIill, Iron, Tinplate, and Kindred 
Trades' Association published a short series of 
articles on industrial diseases as affecting the workers 
in this industry. The subject of pulmonary tubercu- 
losis was dealt with, and it was stated that one of the 
causes, so far as industrial Ufe is concerned, was the 
inhalation of dust at the works. 

The disease known as pneumoconiosis [it was stated] 
is known to kill large numbers of Staffordshire potters, 
Cornish and Transvaal miners, and Sheffield grinders. 
Dust from any cause, especially that produced in the 
manufacture of manure from basic slag, causes bron- 
chitis, asthma, chronic cough, and emphysema and 
pneumonia, and no doubt predisposes the body to attacks 
of the tubercle bacillus. As these dust diseases develop 
insidiously, the workmen engaged in such occupations 
should have their chests examined periodically and any 
signs of commencing disease should be regarded as a 
disqualification for that particular kind of employment. 

This, be it observed, was written in a journal 


belonging to the workers. It reveals the fact that 
they are fully alive to the dangers and necessities of 
their calUng. 

The United States Department of Labour, im- 
pressed by the need of action, has formed a Com- 
mittee on Mortahty from Tuberculosis in Dusty 
Trades, and this body has just issued a preUminary 
report which is of great importance, as outhning the 
work to be undertaken. The State of Vermont, and 
its granite- and stone-cutting industry, form the 
basis of the statistics so far obtained. It was found 
that the mortahty from tuberculosis was extremely 
high in the granite-cutting districts, equaUing 121-8 
per 100,000 of population, as against 81-4 for the 
State as a whole. This is regarded as sufficiently 
important to justify a prolonged investigation. In 
our own country, which has led the way in this work, 
the same kind of investigation was carried out by 
Dr. J. S. Haldane on behalf of the Institution of 
Mining Engineers. 

These findings are of deep interest aUke to the 
employer and to the medical man. Dr. Haldane 
stated quite unequivocally that a sharp distinction 
must be drawn between coal and other kinds of dust. 
He found no evidence in the mortahty returns, for 
either old or young miners, that dust inhalation had 
hitherto caused appreciable danger to Ufe in British 
coalmining. On the other hand, the introduction of 
stone dusting as a practical and effective means of 
preventing coal dust explosions had altered the 
situation, for it had been found that stone dust 
exercises a very baneful effect. 



Dr. Haldane and other workers were able to show 
that, whereas stone dust alone seemed able to pro- 
duce severe lung disease, stone dust plus coal dust 
did not produce this effect. Animal experiments of 
various kinds were carried out, and it was found 
that the cells Uning the air vesicles of the lungs 
seemed to be stimulated by coal dust to unusual 
vigour. Thus stimulated, they carried the dust 
away and eUminated it. If, on the other hand, 
stone dust only was present, this was not got rid of, 
the cells apparently not being stimulated. The 
addition, however, to the stone dust of coal dust 
resulted in the same effects as when coal dust alone 
was used — both dusts were removed from the 


It is evident that these results are of the utmost 
practical importance to the mining industry, for, 
as has been emphasized on several occasions, the 
respirators in use do not as a rule afford the men 
adequate protection. Just recently, however, ex- 
periments with new respirators have been carried 
out by the Bureau of Inspection of the New York 
State Industrial Commission. It was determined 
that with the use of one half ounce of clean absorbent 
cotton, pinned or otherwise fastened to a piece of 
cheese-cloth five inches wide or of coarsely-woven 
muslin of sufficient length to tie about the head, or 
of a length, if preferred, to cover thoroughly nose 
and mouth, all dust would be filtered out for a 
period of four hours or more. The absorbent cotton 
of the respirator should be covered with a small 
piece of musHn or cheese-cloth to prevent the small 



particles of fibre touching the lips or tongue of the 
operator wearing it. 

Such an apparatus, it is claimed, will filter out the 
dust in the air being breathed. It is cheap, light, 
and does not obstruct vision, while it can be changed 
daily at smaU cost. The respirators do not break 
or rust and cause no excessive perspiration. 

Meanwhile from another quarter comes a series 
of important observations on the enormous losses 
suffered owing to dust and on the effects produced 
on the patient when dust is inhaled. In the Journal 
of Industrial Hygiene it is stated that miners' con- 
sumption — and especially stone miners — ranks on 
a par with lead-poisoning as the most dangerous 
industrial disease. The Medico-Actuarial Investiga- 
tion found a mortaUty of 226 per cent of the expected, 
according to the mortaHty table, among miners other 
than coal miners. Studies of individual life insur- 
ance companies have shown mortaUties of over 300 
per cent of the expected, and with the death-rate 
from pneumonia and tuberculosis running seven to 
ten times the average. 

These high rates, as we have pointed out, are not 
in coal mines, but in stone or metalliferous mines. 
They are confirmed on every hand. Thus a big 
mining centre, where the operations were all in 
siHcious rock, showed the following death-rate per 
1000 from tuberculosis alone : 

1906 5*04 

1907 5*55 

1908 6«49 

1909 ^'Ol 


In copper miners in Montana the death-rate from 
respiratory diseases was 9 per 1000 miners, and Dr. 
Haldane found the death-rate among metalUferous 
miners in ComwaU to be (1900-1902) : 







Death-rate . 






We can thus estimate for a death-rate of from 7 to 
10 per 1000 employed from lung diseases in districts 
where hard rock mining is carried on. 

Dr. Landis, of the University of Pennsylvania, 
has recently written in the same journal regarding 
the types and characters of the dusts which are 
dangerous. For example, he declares that the more 
jagged and angular the particles are the greater is 
their power for mischief, a fact which no doubt weighs 
in favour of granite and quartz as disease-producing 
rocks. Again, it has been declared that, in general, 
dusts appear to be more injurious as their chemical 
composition differs from that of the human body or 
from the elements of which the body is normally 
composed. Thus lime dust, a normal constituent of 
the body, though it is angular in form is but feebly 
irritating to the lung. Native plaster-of-Paris is also 
relatively harmless. Cement dust, in spite of enorm- 
ous quantities inhaled, was found to be without 


Other things being equal, it has been found that 
the finer the dust the more dangerous it is. It is 
only the very minute particles which gain entry to 



the lungs. Thus one observer declares that the 
majority of visible siUcious particles, as detected by 
polarized light, in sections of a diseased lung vary 
from 2 to 12 microns in maximum diameter ; larger 
particles were not found in the lung tissue, but only 
fn the cavities of the air tubes. Another investigator 
found, after most careful work, that 1 micron was 
the usual size (that is, a diameter less than one-eighth 
of that of a red blood corpuscle). These particles, 
indeed, accounted for 70 per cent of the whole ; 
only a negUgible number of particles were seen 
whose longest measurement exceeded 8-5 microns, 
and the very largest observed was 10-5 microns 
The prevailing outUne of these particles was 
narrow and elongated, with one or both extremities 

^°N!!t only size, but also concentration of the 
particles is important. For example, if a worker is 
exposed to the dangerous type of smaU dust m a 
closely confined space, the effects are more severe 
and disease changes are more quickly produced than 
if exposure occurs in a weU-ventUated room or m 
the open. 

The very severe effects produced in the gold miners 
of South Africa and the zinc miners in south-western 
mL^i are largely due to the fact that the rock dust 
accumulates in underground passages ««d chambers^ 
In the Rand, holes are bored into the rock wj-h.^f not 
moistened, emit a constant stream of fine dust which 
thorouehlv impregnates the atmosphere; and, alter 
lst°n| sufficient'^ime is not allowed to permit of the 
dust settling. 


The finest dust is produced by blasting; over 

99-5 per cent of the particles are below 12 microns 

in diameter, and the average diameter is under 2-6 

microns. The dust, too, is produced in enormous 

quantities, though only over a short space of time. 

The dust contents of the air, indeed, after blasting 

may, it has been calculated, contain per cubic metre 

as many as 86,000,000,000 particles of a dangerous 

Finally, the length of exposure to the danger is a 
matter of great moment. In most cases four or five 
years elapse before a worker begins to show signs of 
trouble, even where the dust is of the most dangerous 
type, and the conditions are very bad. In the case 
of less dangerous dusts, ten or fifteen years may 
elapse before the mischief declares itself. 

Dr. Landis thinks that it is not so much the 
injury caused to the lung that makes workers in 
these inorganic dusts susceptible to tuberculosis, but 
rather the fact that tubercle baciUi are easily carried 
into the lung in the dust. If an infected worker is 
careless in spitting on the floor, the sputum becomes 
dry, and mixes with the dust, thus making it easier 
for the baciUi to reach the lung. The dark, humid 
atmosphere of the mines, too, may aid in prolonging 
the hfe of the bacilU. It was observed that the 
tubercle bacillus would survive in the acid mine 
water for at least two months. This worker is 
inclined incidentally to think that tuberculosis as 
distmct from injury of the lung, is too often ascribed 
to stone dust, and may in a good many instances 
arise from other causes in these workers. 



The prevention of this industrial disease is by no 
means on a satisfactory basis at present, and a great 
deal of work remains to be done. Meanwlnle, how 
ever, certain clear indications have emerged : 

1. AH workers should be examined on ^^^^jj'^ 
..ines which are ^own ^^ ^ S^L^^^^ b^^^^ed 

n'tf wofke:: thtll be examined P-io JcaUy^^^^^ 
removtd from work at once if any signs are detected _ 
3 Ssinf ection should be carried out as far as possible 

^ f Zl^^L:X^2o.^. be carefully supervised 

6 Respirators should be worn, especially those 
de^gn!d on the American plan, and made as has been 

to be " carefully thought out to ensure that enough 
it " (i.e. the coal dust) " were breathed. 

These precautions, if taken in the silicious trades 
would unquestionably lessen this very real and 
leadly pe^. Later work may, it is to be hoped, 
suggest other methods. 





The safety of the workman is becoming more and 
more a question of poUtical importance. During 
a recent strike a point was made by the men's 
leaders regarding the large number of platelayers and 
shunters who meet with accidents in the course of 
their employment. The same charge has been 
brought by employees in other trades, and in not a 
few mstances the Government has abeady moved in 
the matter. 

In the report of the Chief Inspector of Factories 
for the year 1918 great importance is attached to 
this matter. It was expected that during the war 
the number of industrial accidents would increase 
considerably as a result of the increased amount of 
machinery in use, the adoption of new types of 
machines, and the increased number of persons 
especiaUy women, employed. This expectation 
happily was not realized. 

It was found that '' by continuaUy directing the 
worker's attention, by signs or short notices to 
points of danger ... and also by securintr his 

168 ^ 



interest and co-operation with the management in 
the prevention of accidents, remarkable results have 
been achieved." Accidents were by no means 
always due to machinery. The three main causes 
were inexperience, want of thought, and carelessness. 
Towards the close of the year a meeting of repre- 
sentatives of employers and workers in industry 
generally was convened by the Lord Mayor of 
London with a view to inaugurating an industrial 
safety -first movement on a wide scale. Representa- 
tives of Government Departments attended and an 
association was formed called the British Industrial 
Safety First Association. The object of this associa- 
tion was to make the objects and methods of the 
movement as widely known as possible and to advise 
and assist generally. 

The need for such an organization is evident when 
it is reaUzed that during the year notices were re- 
ceived of 1579 fatal cases, of 53,491 accidents due 
to machinery, and of 108,663 non-machinery cases. 
This vast economic loss and waste and the toll of 
suffering it represents are preventible. Every effort 
ought to be made by every employer of labour to 
prevent it. 

The Factory Department has already begun to 
deal with the problem. Accidents are divided by 
this department into two main classes or groups : 
(1) Machinery accidents and those preventible by 
safeguards ; and (2) non-machinery accidents and 
accidents not due to want of fencing. Of the former 
it may be said that the strict regulations now in 
force regarding the fencing of the machines has 


served to reduce them considerably. A further code 
of regulations has recently been issued and its effect 
is shown by the following reports from divisional 
inspectors : 

Northern Division. — " Perhaps the most notice- 
able progress towards accident prevention has been 
in shipyards. Here there have been great advances 
during the last few years in lighting, in the provision 
of safer stages outside and inside the ship, in methods 
of supporting stages by substituting steel uprights 
and thwarts for wooden ones, and in supervision. 
In supervision certain firms are going considerably 
beyond the regulations, and men have actually been 
appointed, one for each large boat, to supervise the 
lighting alone." 

One firm supplied heavy steel gangways to replace 
wooden ones, the latter having proved dangerous 
when a " rush " of workmen took place. Another 
made great efforts to secure adequate lighting of 
manholes and entrances to holds down which workers 
are apt to fall. A suggestion that these should be 
painted round with an edge of white is made in the 
report, and seems worthy of consideration. One 
large firm on the Clyde has already adopted it, and 
put it into practice. That these precautions are by 
no means too great was illustrated by the state of 
affairs prevaiUng in shipyards which had to be kept 
dark on account of air raids. 

In other trades meetings of employers and em- 
ployed took place in order that an understanding 
might be reached regarding which parts of each 
machine were to be considered dangerous. In some 



cases (e.g. as regards the fencing to be provided for 
draw-bands and pulleys, and scrolls of self-acting 
mules in the cotton trade) the actual form of the 
guard was standardized. It is claimed that a great 
work would be accompHshed if trade by trade the 
fencing of machinery could be standardized. The 
hands of the inspectors would be strengthened 
enormously thereby, and the opposition which they 
now too frequently meet with would largely be 


The absence of guards on machinery is, however, 
a small matter when compared with the personal 
factor. It has been the experience of inspectors 
that at most some 35 per cent of accidents have been 
due to insufficient fencing. The remainder owe 
their origin to the human element, most of all per- 
haps to " want of appreciation of the danger." 

It is manifest that inspectors can do but little to 
cure this state of matters. A remedy has, however, 
been found in what are known as " Safety Com- 
mittees." In one work in which such a committee 
was started the toU of accident was reduced during 
the year by more than 50 per cent. The foUowing 
year a further drop of 12 per cent was achieved. 

When a safety committee is being formed the 
employer should begin by making it clear to his 
people that he really does mean business and that 
he is determined to reduce accidents to the lowest 
possible figure. The committee must, of course, 
represent all the interests concerned, and the en- 
thusiasm of the workers must be enhsted from the 
outset. The officials of the trade unions should be 


consulted, and every effort made to disarm the 
suspicion the workman is apt to feel of schemes 
which originate with his master. 

J'he representatives of the management will be 
nominated by the employer ; those of the employer 
should be elected by the men themselves on the 
basis of one or more members from each department. 
The committee should have the power to co-opt 
other persons for special purposes. Members should 
hold office only for a limited period and should 
retire in rotation. The committee should meet at 
regular intervals, not less frequently than once a 
fortnight, and members representing the workpeople 
should while engaged on the business of the com- 
mittee be regarded by the employers as being en- 
gaged in carrying out the duties of their employment. 
These rules may seem obvious ; but it cannot be 
too strongly urged that, inasmuch as the majority 
of accidents owe their origin to mental factors, the 
means of prevention must be reinforced by general 
acceptance, that is to say, by a friendly and if 
possible enthusiastic attitude of mind on the part 
of the workers. This can only be secured if the 
most complete fairness is shown and if full oppor- 
tunity for discussion is afforded. The men must 
see their own interests clearly and must act from 
an impulse to improve their own condition. 

The chief function of the committee will be to 
inquire into accidents of all sorts and kinds. It 
will be the duty of the employer to furnish the 
fullest particulars of each accident as soon as prac- 
ticable after its occurrence. The committee must 



also have authority to visit the site of the accident, 
to make a fuU inspection, to hear witnesses, and to 
offer recommendations. It should pubUsh an account 
of each accident investigated by it, of the causes 
which led to the accident, and of its own findings. 
The pubficity so obtained has proved to be of great 
educational value. In one case, as the result of 
the public spirit which had been cultivated by this 
means, a safety committee was able to suspend 
from employment workers who had neglected to 
take recognized precautions, and a repetition of the 
offence involved instant dismissal. 

Another duty of the committee is to undertake 
regular inspection of the works in the company of 
the departmental manager or foreman. It is sug- 
gested that : 

They should forward to the employers recommenda- 
tions as to the proper and effective guarding and clean- 
ing of machinery, the repair and maintenance of all 
fencing, plant, passage-ways, and works, as to the 
provision of safety appliances, the regulation of danger- 
ous processes, lighting and ventilation, first-aid and 
ambulance arrangements, and any other matters having 
for their object the prevention of accidents and the 
securing of safer working conditions 

Notices calling attention to danger should be 
striking and simple. A fault of many of those 
shown hitherto has been that they failed to attract 
attention. Moreover, they were not changed often 
enough Good notices should strike the eye and 
also the imagination. In one case a clever device 
was used by which the notice of danger appeared 


only when the guard of some machinery was re- 
moved, thus calling attention to the absence of the 
guard and the consequent danger. The following 
are examples of posters which have been found useful. 
They are taken from a report of an address by Lord 
Leverhuhne to the students of Sheffield University 
entitled '' Standardizing Welfare." 








SEPTIC Wounds, however 
slight, require careful treat- 
ment. Have them dressed 
daily in the Surgery. 



REPORT unsafe places to 
your foreman or manager. 


Finally, the safety committee must set up a 
suggestion box in which any workman may place 
an idea for improving the means of accident preven- 
tion. This plan has already worked well in practice. 
It helps to encourage enthusiasm among the men, 
and so makes for that public spirit without which 
all efforts will prove vain. 

We have insisted upon the value of these com- 
mittees because they promise an immense saving of 
man power and of pain and suffering. But rightly 
handled they promise much more than this. They 
are bound, within a short period, to become health 
guardians in a much wider sense. They will make 
it their business to insist upon reforms which 
promise greater well-being to the worker, and by 
that very act they will secure greater output to the 
employer. * 

We have so far dealt only with the general 
aspects of accident prevention. There is, however, 
an important individual aspect which has recently 
been considered with great care. 

Some people are more liable to accidents than 
others. These persons constitute a danger to all 
who may be working with them. It is thus of 
first-rate importance to understand what are the 
causes which underlie their weakness and how these 
causes may be dealt with. For so long as a group 
of employees contains danger-attracting individuals 
so long will general schemes of safety tend to break 

The subject was considered in all its aspects a 
short time ago on behaK of the Ministry of Muni- 


tions by Dr. Vernon. He collected accident data 
at four factories for periods of nine to twenty- 
five months. In that time some 50,000 accidents 
happened. They were classified separately under 
the headings of cuts, foreign bodies in the eye, 
burns, sprains, and injuries. It was found that eye 
accidents afforded the most reliable index of in- 
cidence, as they were commonly treated within a 
few minutes of their occurrence. Cuts were fairly 
reliable ; strains and sprains quite unreliable, as 
treatment was only sought at long intervals after 
occurrence in many instances. 

It was found that the personal factors influencing 
accidents depended upon several well-defined circum- 
stances, among which speed of production was 
prominent. For example, the output in a certain 
factory rose steadily during the morning spell of 
work and was 1 1 per cent greater in the fourth hour 
of full work than in the first hour. It remained 
high during the first hour of the afternoon spell, 
but fell off during the rest of the afternoon. The 
incidence of accidents showed a qualitative resem- 
blance to these output variations but not a quantita- 
tive one, for accidents increased ten to thirty times 
more rapidly than output during the morning spell. 
It was concluded that this increased speed of 
output was the factor largely responsible for the 
day-shift variations of accident in men, and this in 
spite of the fact that fatigue necessarily played a 
part. For it was found that during the night-shift 
a different state of affairs prevailed. In this, acci- 
dents were at the maximum at the beginning of the 



shift and fell gradually the whole night through tiU 
they reached a figure which was but half the size 
of the figure of the beginning of the night. 

It was found that this remarkable state of matters 
as regards the night-shift workers was due to the 
fact that they started work in a state of some 
excitement and in a careless attitude of mind. 
They " calmed down " as the night progressed. 
Further, in factories where output did not vary 
much there was little variation in the incidence 
of accidents. Yet here also the night-shift figures 
dwindled down throughout the whole course of the 

We have thus two effects — both personal in some 
respect. The tendency to make mistakes when a 
pressure of work is on and the tendency to make 
mistakes when coming to the factory from other 
interests of the day — what may, perhaps, be called 

This, however, was but one aspect of the matter. 
Fatigue also undoubtedly played a part in accident 
production. For example, at a fuse factory, where 
women operatives were working a 12 -hour day, or 
75 hours a week, the accidents were two-and-a-half 
times more numerous than in the subsequent 10-hour 
day period. The men's accidents, as the result of 
this change, were not affected. The women's acci- 
dents showed a five -fold increase during the course 
of the morning spell, as compared with a three-fold 
increase during the subsequent 10-hour day period ; 
but, again, the men's accidents did not change as 
between these two periods. The women's accidents 



were 45 per cent times more frequent in the after- 
noon speU than in the morning spell, while the men's 
accidents were only 7 per cent times more numerous. 
Also the women were treated for faintness nine times 
more frequently than the men, and were given sal- 
volatile twenty -three times more frequently, whereas, 
in the subsequent 10-hour day period, they were 
treated for faintness and given sal-volatile only three 
times more frequently than the men. When the 
hours of work at one of the shell factories were 
equalized for the men and the women, whereby the 
women were made to work nine and three-quarter 
hours more than they had done previously and the 
men nine and a quarter hours less, the ratio of 
women's accidents to men's accidents (corrected for 
the alteration of hours) increased 19 per cent for 
the day-shift and 61 per cent for the night-shift. 

Three great factors of a purely personal kind 
thus emerge — the employee's reaction to speed, his 
reaction to outside influences, and his condition of 
fatigue. As we have seen, reaction to outside in- 
fluences greatly affected the number of accidents at 
the beginning of the night as compared with the 
number of accidents at the end of it. Not only so, 
but it was found that night-shifts were much less 
generally Uable to accidents than day ones— the 
difference was about 16 per cent. 

Finally, there were other factors, which, in a 
different sense, may be said to be personal. Alcohol, 
for example, certainly increased the tendency to 
accident. Lighting exercised a profound influence 
the extent of which necessarily depended to some 



extent on the eyesight of the worker. Thus acci- 
dents due to foreign bodies in the eye were 7 to 
27 per cent more numerous in the night-shift 
than in the day-shift, though all the other accidents 
were considerably less numerous. The excess of eye 
accidents was most marked in the worst lit factories. 
During day-shift work the eye accidents to men 
were most frequent in the winter months and most 
infrequent in the summer ones, though this was not 
observed in the case of women. 

The temperature of the work, too, affected the 
number of accidents. These were found to be at a 
minimum at 65° F. to 69° F., and they increased 
rapidly at higher temperatures (e.g. by 30 per cent 
at temperatures above 75°) and increased slowly at 
lower temperatures. It was also found that acci- 
dents tended to increase as the weather grew colder 
and to diminish as it grew warmer. In one factory 
the women's accidents were nearly two -and-a -half 
times more numerous when the temperature was at 
or below freezing point than when it was above 
47°, while the men's accidents were twice as numer- 
ous. Incidentally it may be noted that the women 
suffered twice as frequently as the men from sprains, 
and were especially Hable to wrist sprains. The 
women at the shell factories also suffered three times 
more bums than the men, chiefly from the hot metal 
turnings: Talking in the shops was found to in- 
crease the number of accidents. 

If we look at this valuable information from one 
point of view, we shall see the necessity of better 
factory conditions, warning notices, and so on. But 


if, while recognizing the great importance of such 
reforms, we alter our standpoint and look at the 
personal side we shall perceive a new necessity, for 
it will become clear that in any given work there will 
always be a few employees — 

(1) Whose nervous system is so constituted that it 
cannot stand pressure of work. 

(2) Whose physical health leads exceptionally rapidly 
to a state of fatigue, and is incapable without disturbance 
of tolerating changes of temperature, excitement, and 

so on. 

(3) Whose careless methods defeat all efforts to con- 
trol them. 

These are the accident-makers who may be ex- 
pected to produce trouble wherever they go. The 
danger attending them is no imaginary one, as a 
remarkable report just presented to the Medical Re- 
search Committee and the Department of Scientific 
and Industrial Research clearly proves. The report 
is the work of Dr. Major Greenwood, of the Lister 
Institute, and IMiss Hilda Woods, of the Ministry 
of Munitions. 

These workers set before themselves three possible 
accident hypotheses. First, that industrial accidents 
are a pure matter of chance, accidents, that is to 
say, in the strictest sense of the term as if " one 
draws the ace of spades from the well-shuffled pack." 
Secondly, that there is another element present— 
** that an accident having happened to any individual 
that individual's chance of sustaining a second acci- 
dent became different from what it was before." 



This train of events is common enough in life. A 
man may, for example, suffer from a disease and so 
establish a new relationship to that disease — i.e. his 
chance of getting it again may be much diminished 
or it may be greatly increased. 

Thirdly, it might be supposed that all workers 
did not start equal, but that some were more liable 
to suffer casualties than others. For example, if 
we suppose that the employees of a firm were divided 
into careful and careless persons, then the chances 
of accidents among the careless would be greater 
than among the careful. 

It was perceived that if the first idea was correct, 
all that was needed for accident prevention was 
administrative reform ; if the second was correct, 
rest-periods and general attention to hygiene might 
overcome the nervous tendency of the victim of an 
accident to precipitate another accident. If, how- 
ever, the third idea was found to be the true one, 
it would follow that " both initial selection of re- 
cruits and also a rapid elimination of those sustain- 
ing multiple accidents should have a great effect in 
reducing the casualty rate of the factory." 

In point of fact, the research did point to the 
correctness of the third view, though the number of 
cases investigated seems too small to admit of 
absolutely positive findings. It wiU thus be seen 
that there is at least a strong presumption that the 
prevention of accidents cannot be achieved in full 
measure unless steps are taken to deal with the per- 
sonal factor. In most cases an accident is a small 
matter of a cut or a bruise. But there are certain 


types of work in which an accident assumes dreadful 
proportions and in which the mistake of one man 
may involve hundreds of fellow-workers in death 
and disaster. 

In such works and factories it is of vital moment 
that the accident -maker should be found and 
ehminated. There is now enough e\ddence to 
justify this step, for the presumption is strong 
that if he is allowed to remain at work he will be 
the source of more and more trouble. One day he 
may, by his constitutional defect or his carelessness, 
become the cause of a great disaster. 



In the first place, it should be pointed out that an 
Order on this subject has been issued by the Home 
Office under section 7 (2) of the PoUce, Factories, etc. 
(MisceUaneous Provisions), Act, 1916. The two 
fundamental principles of these Orders, as outlined 
by Dr. Bridge, H.M. Medical Inspector of Factories, 
are : 

(1) To treat, all wounds, however trivial, so that the 
workman may quickly return to his work in comfort 

and safety. 

(2) To prevent, as far as possible, serious accidents 

from becoming more severe. 

The chief risk in respect of the sUght accident is 
blood poisoning, which, setting in at the site of a 
tri\ial wound, may spread to a fatal issue. Treat- 
ment must, therefore, be immediate, simple of 
appUcation, and efficacious. The dressing appUed 
should, in fact, reduce all risk of the possibihty of 
the entry of germs to the wound. For it must be 
remembered that blood poisoning comes from with- 




out ; the poison is produced by germs which enter 
the wound and breed there. 

SimpUcity is important, because the larger the 
number of persons who can be taught how to apply 
a dressing the more chance there will be of getting 
a wound treated rapidly, and speed is of the essence 
of the contract. The French Government, for 
example, found that by moving hospitals nearer to 
the front the percentage of cases of blood poisoning 
was greatly reduced — treatment began at an earlier 

Again, the dressing must be of such a type that 
it can be applied mthout the part wliich is to touch 
the wound being handled. A first-aid box con- 
structed to carry this type of dressing can now be 
obtained. In one factory a reduction of approxi- 
mately 50 per cent in the number of septic or 
poisoned cases has followed the use of this box. 

The box should contain a number of the steriUzed 
dressings, done up in sealed packets. Boxes should 
be placed in the works, in positions within easy reach 
of all the persons employed. It is important to see 
that the dressings are of several types and sizes, for 
a dressing cut and designed for a wound of the body 
or face cannot be used in a satisfactory manner to 
protect a cut finger. The Orders referred to above 
require dressings for the finger, hand, or foot, and 
large dressings for other parts of the body. 

There has been a good deal of trouble in con- 
nexion wdth this question of the size of dressings in 
the first-aid boxes, and a conference of the principal 
manufacturers of surgical dressings was held on the 




subject in which the whole field was carefully re- 
viewed. The question of standardization was dis- 
cussed. As a result more suitable shapes have been 
provided, but it is urged that those who find diffi- 
culty should make their complaints known at once, 
so that further improvements may be initiated. 

The use of roUs of unsteriUzed Hnt and gauze in 
the first-aid boxes is not to be encouraged. These 
rolls get handled and moved about, and quickly 
gather dirt. FinaUy, they are applied to a wound, 
and the contained dirt is then transferred to the 
exposed parts, with, it may be, evil consequences. 

The instaUation of the first-aid boxes will be of 
Httle avail if instruction in their use is not given 
to the employees. The best thing is to organize 
a series of first-aid lectures. AppHcation should be 
made to the St. John Ambulance Association and 
the services of a doctor obtained. Classes can then 
be formed and instruction given. 

A course of instruction in first aid on somewhat 
new fines arranged by and under the supervision of 
Dr. T. W. Woodhead, of the Technical College, 
Huddersfield, has been begun in that town. The 
course is divided into two parts, elementary and 
advanced ; the former is Hmited to instruction in 
the use and appUcation of the first-aid dressing and 
such treatment as can be carried out in the work- 
room or the first-aid box. The advanced course 
deals with first aid generally, and as the syllabus is 
approved by the St. John Ambulance Association 
those taking the full course are quafified to enter for 
the examinations of the Association. Attention is 




paid in Huddersfield to gassing accidents in con- 
nexion with the manufacture of dyes. Each industry 
has its own special problems and these would be 
dealt with in the course of lectures. 

The next Hne of defence is the ambulance room. 
" It is not generally realized," writes Dr. Bridge, 
*' that wounds that require treatment other than 
the application of a sterilized dressing are not of a 
nature that can be successfully dealt with in the 
workroom." Even in these cases, however, the 
immediate application of a steriHzed dressing from 
the first-aid box lessens the risk of infection, which 
may well take place during the transit of the patient 
to the ambulance room — one need only mention the 
case of a compound fracture in which the broken 
end of the bone is a veritable sponge for dirt and 
germs. But beyond the application of the dressing 
no attempt should be made to treat wounds in the 
workrooms. Indeed this kind of zeal must be dis- 
couraged, for the washing of wounds is in itself a 
minor surgical operation. If this is carried out 
with dirty hands by unskilled persons great harm 
may result. 

The ambulance room is required by order in 
factories employing 500 or more persons, and all 
factories should be provided with it. If this cannot 
be done, however, equipment such as tourniquets 
to arrest bleeding, and splints may be included in 
the first-aid boxes. In one factory a well-equipped 
first-aid " dressing station," the size of a telephone 
cabinet, with a stretcher, chair, and other additional 
equipment, has been provided. 



The ambulance room is of great importance and 
should be chosen with care. It should be in such a 
position that it can be reached easily from all parts 
of the factory ; and it should be possible to carry 
stretchers into it with the minimum of inconvenience 
and danger. This is a matter of real concern, for 
in cases of serious accident much moving and 
manoeuvring of the stretcher is greatly to be de- 
precated and may prove disastrous. The best plan 
is to have the room built according to a recognized 
plan ; if this cannot be done an existing room must 
be adapted. See that the lighting is good, the door 
wide, and the floor space sufficient. 

In one instance, a large engineering works where 
this accommodation has been provided, each ambul- 
ance room is lighted on one side with ordinary 
casement windows and on the other side with large 
plate-glass windows over the doors. These windows 
practically constitute the wall and afford excellent 
illumination. The floors are of terazzo over cement, 
and the waUs and ceiling parian cement covered with 
washable enamel. All corners are rounded as in an 
operating theatre, and the woodwork is white 
enamelled. In this way the whole apartment can 
be washed down daily and the chances of infection 
taking place reduced to a minimum. The precau- 
tion may seem superfluous, but the fact remains 
that in the presence of this good equipment cases 
of blood poisoning become few and far between. 
Each ambulance room is fuUy equipped with a 
steriUzer for instruments heated by electricity, a 
cabinet for instrumenls with the usual glass shelves, 


etc., a dressing wagon, a screen, a table, a chair, 
and a couch. There is also a lavatory basin of 
good design and a " surgeon's sink." The supply 
pipes to these fittings are enclosed and the wood- 
work is white enamelled. 

This may be said to represent the ideal. On 
the other hand, many ambulance rooms have been 
converted. In some of these defects can be seen ; 
for example, bad lighting, poor ventilation, wooden 
floors, and wooden panelling of the walls. The 
trouble about these latter is the difficulty of keeping 
them clean. 

It is important that for quiet and cleanliness the 
ambulance room should be separated from the work- 
rooms as far as possible. It should also be separated 
from the sanitary arrangements if possible. It 
should be heated in winter, preferably by means of 
water pipes, these being enamelled white Uke the 
rest of the fixtures. 

It is naturally of great importance to see that 
the person in charge of this room is competent in 
every way. He or she should have had considerable 
experience in the treatment of wounds. A trained 
nurse answers the purpose well, but care must be 
taken to ensure that the *' nurse " employed really 
does answer to that description. She should have 
been trained in a general hospital of standing, and 
possess a certificate to that effect. Persons holding 
first-aid certificates are not suitable, except as 
juniors to a fully-trained nurse. The nurse need not 
confine her attention to the ambulance room ; she 
should exercise a general supervision of the first- 



aid boxes, and also exert her influence in other 
directions making for health and hygiene. 

In the case of small firms a nurse of the right 
kind may be rather too expensive a luxury. In 
Sheffield several small firms, whose works are 
adjacent, have joined together to employ a highly- 
trained nurse who visits the ambulance rooms at 
appointed hours, re-dresses old cases, and sees all 
cases referred to her by the first-aid attendants. 
FinaUy, a medical man should be on caU for severe 
cases, arid the addition of a telephone to the ambul- 
ance room would be valuable so that no time might 
be lost in summoning the doctor. 

The organization of personnel would thus be— at 
the centre the trained nurse, able to communicate 
from her ambulance room with a doctor, and having, 
perhaps, a first-aid assistant ; at the periphery a 
series of first-aid boxes, each in charge of an m- 
dividual who has had a course of training in first 
aid. In addition, squads of workers, also trained 
in first aid, should be organized throughout the 
factory. Each squad would work in connexion 
with a first-aid box, and the captain of the squad 
might be the box attendant. The squad would 
possess a stretcher and undergo "drill" in the 
use of it from time to time on the lines of the 
St. John Ambulance regulations. 

It has been suggested that in works in which a 
" Safety First " committee has been constituted, a 
sub-committee to deal with first aid should be formed. 
This sub-committee, on which master and men 
would be represented, would have oversight of the 


whole first-aid organization in consultation with the 
medical man whose services had been retained. 
Reports of all accidents should be submitted to this 

There is a final point of great importance. The 
ambulance room should be suppUed with a few 
simple restoratives— brandy, sal-volatile, and other 
substances. In addition, the doctor might be invited 
to suggest a Hst of necessary antiseptics and drugs 
which the nurse could be trusted to use. 



Few employers of labour appear to realize that there 
is no greater enemy of efficiency in industry than 
mere noise. The noise of machinery is accepted as 
being almost a commonplace. The din and bustle 
of a warehouse is regarded as part of the daily 
round. That this clatter, this din, are eating away 
profits is not recognized, for the reason that the 
effect of mere noise upon the human machine has 
not been taken into consideration. 

So far the subject has been studied only in the 
most casual manner. Thus statistics of output in a 
properly silenced factory are not available because, 
so far as is known, no such factory exists. When 
the subject is mooted the reply is that, after all, 
noise is only heard by the newcomer. The man 
who works among machinery every day ceases to 
hear it ; its clamour becomes a part of his " mental 
environment," so that were the clamour absent he 
would be aware of a sense of loss. 

This view is, no doubt, in accord with experience. 
It misses, however, the point in dispute, which is 



whether or not efficiency can be increased by 
eliminating unnecessary noise. It is here that 
further research work is so urgently required, for at 
the present moment waste, and especially waste of 
human material, is not only extravagant, it is 

In the meantime we may turn for Hght to some 
recent scientific work on the nervous system in 


relation to the wear and tear of everyday life. The 
investigations of a great number of workers, in- 
cluding such well-known names as Langley of Cam- 
bridge, Cannon, and Crile, have directed attention 
to the enormous importance of the nervous system 
in the bodily economy. This system used to be 
regarded as a kind of telephone-exchange mechanism; 
we must now rather accept it as the administrative 
organization of the body. To it belongs the function 
of dressing our bodies to meet the contingencies of 
life and of marshalling their resources while the 
struggle is going on. The " steadiness " of the 
trained worker is thus something more than a mere 
expression of facility ; it is a demonstration of 
perfect equipoise between the various parts of the 
nervous system, and so of harmony in the organic 
relationships of the body. Every stimulus meets 
with an adequate response. The call to each effort, 
to each fraction of a composite movement, is met 
at once and completely, but without waste. The 
process, in fact, appears to be entirely automatic 
and entirely free from effort. 

This view of it, however, is really fallacious and 
accounts for some of the gravest mistakes which 



organized industry commits, and goes on committing. 
There is really, indeed, nothing automatic about the 
so-called automatic process. Just as a train running 
round a curve at high speed takes toll of wheels 
and rails, so man in his most deft actions takes 
toll of those mechanisms which keep him " on the 
rails " of efficiency. The speed of the process, when 
it has been well learned, by no means mitigates this 
strain ; it merely disguises it. 

Some recent work on aeroplane pilots has proved 
instructive in this respect. A man goes off his 
*' flying form," as it is called, in all sorts of odd 
ways and as a result of a large number of different 
circumstances. The addition of other stimuli to 
those which he is accustomed to encounter may 
precipitate a crash. So may mental worry ; so 
may intemperance. It would seem that the nervous 
system is attuned to meet certain conditions, and 
that the presence of others upsets this balance. 
But, more important, it would seem that each 
additional stimulus, however constant, makes an 
additional demand on the resources of the nervous 
system, for if the pilot is " off colour " he can stand 
only so much stress and strain, no matter to what 
high degrees of both he has been accustomed. 

To come to a more homely illustration ; the 
piano practice to which one has perforce become 
accustomed can be tolerated in ordinary circum- 
stances. But a slight illness arises, and then the 
sound of the difficult and inharmonious playing 
grows intolerable and is not to be endured. En- 
durance has been lowered ; there is less of it avail- 




able for use. Thus it would seem that endurance, 
tolerance, call it what you will, is a form of expendi- 
ture of energy, and no mere passive quality that 
may be expressed without loss or effort. 

The train keeps the hne in virtue of the flanges 
on its wheels, and the bedding of the rails in " chairs " 
and " sleepers." But this is not the whole of the 
problem by any means. In taking the curve energy 
is eaten up on the resistance encountered between 
wheel and rail. In the same way your automatic 
worker, who is apparently entirely oblivious to his 
environment, is really using up energy in order to 
produce his state of oblivion. He has achieved the 
difficult feat of concentration. His attention has 
been divorced from his surroundings and their calls 
upon it. So long as he is well he will be able to 
defy any distraction. But if he falls sick his first 
complaint will be that he " cannot concentrate " 
and that every trifling noise disturbs him. We 
surround our sick with silence for their healing. 

Noise, then, is no negative and negligible factor 
in Hfe ; it is positive and active, and it can be 
ignored or discounted only by the expenditure of 
effort. This truth may be more clearly understood 
if the mechanism of response by the body to stimuli 
from the outside world is understood. Each of the 
special organs of sense, the eyes, the ears, the nose, 
the tongue, and the skin, is connected with the 
brain by nerves. These nerves in turn act upon 
certain groups of vital nerve cells, or " centres," 
which control the breathing, the action of the heart, 
the flow of blood through the abdominal organs and 



muscles. Thus, in response to a call for action a 
man's breathing becomes altered in quaUty, his 
heart beats more strongly and more quickly, his 
blood is pumped from his belly to his brain and 
muscles. He becomes alert and ready for work or 
for battle, and this at the expense of a rapid con- 
sumption of his bodily resources. 

If, however, experience teaches him that the 
stimulus, be it light or sound or smeU, demands no 
action on his part, his response to it will gradually 
diminish. He will, apparently, ignore the call and 
go on as if nothing had happened. He accomplishes 
this by means of what is called " inhibition," or 
repression ; i.e. he represses the natural tendency to 
make a fuU response. 

In other words, his nervous system refuses to 
pass the order to mobiUze ; " blocks " it, so to 
speak, and so protects his bodily mechanism against 
needless shocks and alarms. But tliis " blocking " 
function of the nervous system is itself an expendi- 
ture of effort according to the scientific observations 
which we have quoted. If it is prolonged fatigue 
results, as is seen in the case of the person who can 
no longer concentrate his attention and so becomes 
unpleasantly aware of the circumstances of his 
surroundings. Consequently the rule emerges that 
the fewer the number of stimuli reaching a worker 
and miconnected with his work the more easy will 
it be for him to do that work efficiently and over 
a prolonged period. 

The view that the worker " becomes unconscious 
of noise " is thus placed in an unfavourable light, 



even if we admit, as we must do, that controlled 
experiments on the subject are few and far between. 
In learning how " not to hear " the noise energy 
is expended, and still more energy is expended 
from day to day in continuing not to hear it. The 
nervous system is bearing a burden which decreases 
the amount of its total value as an organizer of 
work ; the margin of safety is, by this amount, 
narrowed. What might have been given to positive 
output has been expended in a negative manner. 
In the last issue the employer himself must pay the 
cost of this dissipation. He is in exactly the same 
position, indeed, as the master who allows his 
workroom to remain unventilated and in con- 
sequence obtains less for his expenditure than he 
would obtain were a proper system of air currents 

But, as we said above, the matter of noise cannot 
yet be set out in tabular form as a profit and loss 
account. Too long hours, bad lighting, bad feeding, 
bad ventilation have all been reduced, as we have 
shown in previous chapters, to simple matters of 
pounds, shillings, and pence. The noisy factory has 
not come within the scope of such a research. It 
represents one of the thousands of problems which 
every enUghtened employer will soon be considering, 
and upon which he will demand positive information 
in the name of business efficiency. 

The test should not prove difficult of achievement 
and in our view is well worth making. Two shops 
or rooms engaged in producing the same article or 
** part " might be set aside as the basis of experiment. 



The output of each of these should be carefully 
recorded during a certain period, allowances being 
made, so far as possible, for inequaUties, e.g. skill of 
employees, hghting, ventilation, and so on. One of 
the rooms should then be " silenced " so far as 
possible, i.e. the noise of machinery or of working 
processes ehminated by every possible means. The 
other shop would be left in its former state of 
noisiness. Output should then again be recorded 
over a stated period and the results compared. It 
would then be a simple matter to estimate whether 
or not increased output in the silenced room paid 
for the cost of transformation. In addition, the 
views of the workpeople would prove of great value, 
for it is abundantly true that every step which 
makes life more tolerable and more comfortable for 
the employee redounds to the ultimate advantage 
of the master. 

The present state of industry in regard to noise 
is undoubtedly very bad. Most factories and very 
many workrooms are excessively noisy, and induce 
headache and great weariness in those who visit 
them only at intervals. It is perhaps largely the 
fault of the machines, which were evidently designed 
in most instances without the smallest regard to 
the noise they were likely to make in working. In 
every direction, however, improvements are now 
being made, and it is a fact, gleaned by personal 
observation and inquiry, that those who operate a 
quieter type of machine would never wilUngly con- 
sent to return to a more noisy type. 

This, therefore, is one of the grounds on which the 


medical man and the scientific engineer meet for 
the mutual benefit of labour and capital. If the 
doctor formulates a demand for a silenced industry 
and supports it by facts and figures — and this we 
do not doubt he can easily do — the engineer will 
have a clear mandate. Experience has shown that 
he will not fail to evolve new types of machines 
which will rid the industrial world of one of the 
many useless burdens it is at present bearing. As 
in the case of the abatement of smoke nuisance, we 
shall all be the richer for the change, and many of 
us in addition will be spared the severe ordeal of 
nervous breakdown, which, in times of bodily weak- 
ness, is so apt to occur when our environment 
habitually overtaxes our powers of restraint. 

Professor Waller has recently made an effort to 
record and measure the effects of shocks, of noise, 
and so on, when these, apparently, give rise to no 
outward effect, no muscular movement. His first 
point was to show that such electrical disturbance 
can occur quite independently of muscular move- 
ment of any sort. For this purpose an apparatus 
was built up which recorded simultaneously the 
electrical phenomena and the movements of groups 
of muscles. The patient lay in an armchair reading 
an unexciting book and often became sleepy in this 
situation. A stimulus calculated to arouse emotion 
was now made. The recorder of muscular movement 
was of sufficient delicacy to show the pulse and to 
respond to the slightest unconscious movement. 

It was found that there was a most remarkable 
electrical response even to mere ideas, when no 



muscular movement might take place at all. More- 
over, the most effective ideas were those accompanied 
by disagreeable or painful emotions. The threat of 
a burn often proved more effective, for example, 
than the burn itself. Lighting a match might give 
a larger effect than the appHcation of the match to 
the hand. The fear of a bad smell that had just 
been experienced proved in certain instances to be 
particularly effective in arousing an electrical dis- 







FiQ. 14. 

turbance. So also the expected prick of a needle 
produced more effect than an unexpected prick. 

This is well shown in the accompanying figure, 
which is after Professor Waller. In this figure 
tracings are shown of electrical disturbances and 
of muscular movement. The patient was a Belgian 
who was an eye-witness of episodes in the German 
occupation of her country. It will be seen that the 
muscular movements are faithfully recorded, for at 
the point marked x the little finger was raised, and 




this is duly recorded by a twitch of the apparatus, 
and so a loop on the Une, and a sudden disturbance 
of the electrical record. When, however, the word 
*' Belgium " was spoken there was no muscular 
movement, but there was a sharp rise in the electrical 
record, or what is called an " emotive effect." 

Professor Waller takes the view that emotion 
acts along those nerves which have to do with the 
nourishment and sustenance of the body, and which 
are called, in consequence, the " trophic nerves." 
The ordinary visible signs of emotion, muscular 
movements, flushing, increase of heart action, sweat- 
ing, and so on, are in fact phenomena which normally 
occur side by side with the electrical disturbances 
he is dealing with. It is possible, to some extent 
at any rate, to prevent these grosser manifestations 
— to inhibit them, in scientific language, so that no 
effect is apparent. On the other hand, the emotive 
effects which are manifested electrically are not 
under voluntary control, and so cannot be inhibited. 
It thus follows that : 

The more perfectly an examinee can control the 
visible signs of his emotion, the more violently is the 
galvanometer deflected ... by reason of his suppressed 

The accompanying record of the last great air 
raid over London furnishes an extreme illustration 
of this tell-tale electrical method of emotion study, 
and illustrates how impossible it is to supress these 
phenomena : for the patient preserved a very calm 
exterior throughout the ordeal. 



But the matter goes considerably farther than 
has been suggested so far. Professor Waller found 
that his subjects reacted to his stimuli in varying 
degrees ; and the same subject reacted differently 
at different times of the day and in different states 
of health. In other words, this electrical reaction 
was a means of measuring not only emotional effect. 

Air raid oP Whit Sunday 1918. 

M GM S . 

fiiM}H -Emotive response to cfie /Airreid oF May 19-ZO. 
fA. First werning by maroons. 
6. Commeneement oF GunPire.eU^ 
H. /Aeroplane hum very audible. 
S. Second wanning signal by siren 

Fig. 15. 

but also bodily condition — ^it indicated that bodily 
condition alters appreciably with work done and 
with the onset of fatigue. 

Tliis view led to the employment of a device 
whereby the amount of " work " done by a man 
could be measured in terms of the amount of 
expenditure of his own bodily or nervous energy. 
This *' work " is not, of course, the same thing as 
output. It may be very much greater, since the 


man may be expending useless efforts in combating 
the effects of noise and stress. 

Professor Waller took a dock labourer, and 
obserred him from hour to hour, noting the amount 
of carbonic acid gas being breathed out — this giving, 
in his view, an index of the energy being used up. 
He found that the labourer, who was doing time- 
work, breathed out during the first hour or so 
6 cubic centimetres of carbonic acid gas per second. 
Later in the morning he was, however, breathing 
out 10 c.c, and later still 15 and 20 c.c. This 
increase of the gas breathed out indicated the onset 
of fatigue, for it was abolished after the dinner- 
hour, to make its appearance again during the 
afternoon. Thus the expenditure of energy became 
greater for the man as he became more fatigued, 
and his electrical phenomena altered accordingly. 
Over the whole day the amount of carbonic acid gas 
breathed out per second averaged out at 14. 

Later, a piece-worker was subjected to the same 
test. He was also an experienced worker, a member 
of a gang of six men who were paid so much for so 
many tons of coal handled. The gang shared profits 
and consequently exercised a certain measure of 
control over one another. Any member who showed 
signs of weakness or slackness was unlikely to be 
tolerated for any length of time by his companions. 
In the circumstances the work done by an individual 
member could be taken as maximal. 

The results showed that the piece-worker's out- 
put of carbonic acid gas rose more rapidly than the 
time-worker's, going up to 25 cubic centimetres per 



second before dinner and above 30 c.c. after that 
meal. The average for the day was 21 c.c. per 
second as against the time-worker's 14 c.c. per 
second average. In other words, the physiological 
cost of piece-work to the worker and of time-work 
to the worker are in the relationship of 3 to 2. 

Figures 16 and 17 show this graphically. The 













a — 


z /? 


7am S 9 10 II 12 t 


2 3 4 5 

Fig. 16. — Piece- Worker. 

















— /? 

CJ 1 


9.m. 6 9 10 II 12 Ipjn. 2 3 '^ 5 

Fig. 17. — Time. Worker. 

point for the employer is that the mental circum- 
stances of the two kinds of work determine its 
intensity and so its cost to the employee. The 
man with the incentive spends more of his energy — 

reacts more. 

This is of course an excellent thing where the 
circumstance makes for productive labour. It is 
the opposite where the circumstance absorbs energy 


unproductively — e.g. noise. Professor Waller was 
able to exaggerate at will the phenomena of energy 
being spent — the electrical reaction — by bringing 
certain outside factors to bear on his subjects. He 
says : 

One can record by apparatus and register by photo- 
graphy the effect of the receipt of an agreeable letter 
and the effect, in exact contrast, of a disagreeable one. 
One can say for example that one letter is 20,000 ohms 
more disagreeable than another. One can in effect 
measure m units of resistance, in ohms, the character, 
whether more or less disagreeable, of any piece of news. 
Any cause acting on the nervous system exaggerates 
these phenomena. 

. Thus the worker whose mind is troubled, who is 
badly fed, whose home life is uncomfortable, whose 
workroom is noisy, ill-lit, or overheated, can be 
shown to be expending himself in an exaggerated 
manner in meeting these adverse conditions. Giving 
to bad objects he has less to give to good ones. 



We have dealt with various particular aspects and 
with various special trades. But so far no special 
mention has been made of that wider and more 
general effort at amelioration which is known as 

*' welfare work.'* 

Before the war " welfare work " meant as a 
general rule sporadic effort by a few charitably 
minded employers, and this in spite of the fact that 
a great awakening had begun in several directions. 
The war, however, demanded the utmost of every 
man and woman employed, and it very soon became 
evident that^elfare work, far from being a philan- 
thropic amusement, was a most important and 
valuable method of keeping what has been called 
** the human machinery " in good running order. 

The first Welfare Orders made under the Act of 
1916 came into force in December 1917. One of 
these affected factories in which the manufacture of 
tin or terne plates was carried on, and demanded 
that protective clothing should be worn in pickHng 
and wet processes (all persons), with simple cloak- 




room for women and girls, mess-room and washing 
facilities (all persons), under responsible supervision. 
Another Order required a convenient supply of 
wholesome drinking water in every factory or work- 
shop emplojdng 25 or more workers. Another Order 
dealt with first aid at blast furnaces, copper mills, 
iron mills, foundries, and metal works. This Order 
was later, 1918, extended to saw mills and factories 
in which articles of wood are manufactured. Two 
Orders made early in 1918 apply to trades in which 
bichromate of potash or soda is used in dyeing and 
tanning. The measures enjoined include protective 
clothing, first aid, suitable accommodation for 
clothing put off during working hours and arrange- 
ments for drying it, simple mess-room arrangements, 
and washing facilities. Similar measures are re- 
quired in glass bottle or pressed glass manufacture. 
A final Order demanded facihties for sitting for 
women in certain munition works. 

These measures have had a definite effect in 
arousing the workers to a new interest in their own 
well-being and in causing employers to perceive that 
welfare arrangements may greatly help to foster 
good relations in industry. The result has been 
that further improvements have been discussed. 
Miss A. M. Anderson, principal lady inspector of 
factories, has suggested recently the importance of 
welfare supervision of workers, the setting up of 
canteens, and the provision for preparing as well as 
heating food. 

The Orders above enumerated have been observed 
in most instances in a satisfactory manner. Even 



small firms, usually slow in these matters, have made 
attempts in certain cases to go beyond the require- 
ments of the law. On the other hand, in the small 
clothing factories and workshops, largely occupied 
by Jews, in great centres, such as Leeds and East 
London, there is a. far lower standard of personal 
welfare than in the great clothing factories. It has 
been suggested that in these small factories and 
workrooms occupiers should be grouped as regards 
responsibility for mess-rooms and cloak-rooms under 
a common provision for superintendence and main- 

Some of the large firms are very keenly alive to 
the advantages of doing all they can in this direction. 
For example, boys' clubs have been started in some 
of the most progressive works, which afford facilities 
for physical culture and for ambulance classes. In 
some instances supervisors are engaged for this work, 
and these 

visit men and boys who- are ill, consult with them as to 
difficulties in their work, and bring any grievance to 
the notice of the management, obtaining lighter work 
for boys who are too weak for their assigned tasks. . . . 
Some of the supervisors engage all boy labour, and 
others are responsible for securing compliance with 
certain requirements of the Act, e.g. hours of work and 
certificates of fitness. 

In a large factory in the Midlands conciliation boards 
have been formed to deal with disputes as soon as 
they arise. The result is said to be " absence of 
any labour trouble in the factory." 

In certain instances it appears that the workers 


are coming to regard welfare conditions as a kind 
of test of employers. Advertisements of good con- 
ditions are now used when seeking workpeople, in 
addition to promises of good wages and permanent 
work. Yet many industries are behind. One in- 
spector commented on the good effect produced 
when 1300 cotton operatives were recruited for a 
large, well-found munition factory in a district where 
women had been found " taking their meals while 
sitting on the floor of a gassing room and apparently 
liking it.'* 

A West London inspector calls attention to the 
difficulties experienced in certain of the great London 
stores and shops. Most of tlie firms are doing what 
they can, and new buildings projected include, as a 
rule, canteens, recreation -rooms, and rest-rooms. 
Unfortunately in certain houses changes are not 
easy. For example : 

The present system consists of each section being in 
charge of a fitter, who is an autocrat in her own depart- 
ment and brooks no interference. The state of the 
rooms therefore varies according to the temperament of 
the fitter — being clean if she has theories on the subject 
of cleanliness, but not otherwise ; warm if she likes 
heat, and so on. She engages her own workers, so that 
it is difficult for the firm to ascertain whether, for 
example, certificates of fitness are being obtained, or if 
the young persons are attending school regularly. The 
general arrangements as to cleaning and upkeep of mess- 
rooms, passages, lavatories, sanitary accommodation, 
etc., are in the hands of charwomen and cooks, and are 
not under any one person's definite supervision, unless 
it be the workroom manager, who is content so long as 



she receives no direct complaints. The result is that 
the mess-rooms are gloomy, dingy apartments, and the 
sanitary and lavatory arrangements are old-fashioned 
and only fairly well kept. 

These troubles, it is contended, would be remedied 
by the appointment of an experienced weKare 
worker. It would benefit the employers to make 
this appointment, more especially when other em- 
plojjjers are even going to the length of fitting up 
tennis courts, taking houses on the coast to which 
sick and seedy workpeople may go for rest and 
change of air, and supplying small gardens and 

The most essential welfare arrangements may be 
said to be, first, a good supply of clean drinking 
water ; second, arrangements for food ; thirdly, pro- 
tective clothing ; fourthly, facilities for personal 
hygiene ; fifthly, seating accommodation ; and 
finally, supervision. Drinking water must be laid 
on in such a manner that it can be reached easily. 
Strong arguments have been advanced in favour of 
what is called the upward jet system by which the 
worker drinks the water as it rises up to him. The 
value of this installation is that in many trades 
cups cannot be kept clean, for instance, oil refining, 
grease extraction, fish manure making, and so on. 
This consideration also holds good in hot and dusty 
trades. The water supply should not be out in the 
open in trades in which the workers have to support 
a hot atmosphere — e.g. the cotton industry. The 
change from the warm factory to the chill air is a 
direct incitement to respiratory and other diseases. 

1 1 

■^ :^&mf. 


Common drinking-cups are open to objection also 
on the ground of danger of the spread of disease. 

Canteens undoubtedly helped the munition 
workers to achieve their great and sustained labours. 
The workers generally do not care to go out to 
meals, and often find difficulty in obtaining the kind 
of food they require. Thus they are apt to suffer 
in bodily strength to the great detriment of them- 
selves and their work. The mess-rooms need not 
be very elaborate, but they must be clean. At an 
old wooden mill in the country outside Bradford a 
very successful room was set up as follows : 

An old low mending room with the use of lots of 
white enamel paint and addition of extra windows has 
been made into a most excellent canteen, with a kitchen 
for light refreshments at one end and small rest-rooms 
for men and women at the far end. The dinners are 
sent down daily ready cooked in vacuum containers 
from the main works, and are said to arrive in excellent 
condition and very hot. All the 140 workers take 
breakfast in the canteen, which is fully equipped, and 
quite 50 take porridge every morning ; 130 stay to 
dinner, a very large proportion taking the full dinner. 
Tea is taken round to the workers during the afternoon. 
Washing accommodation with hot water laid on is tiow 
(in 1919) being installed in the factory, and numbered 
pegs for clothing for each worker. 

Protective clothing came into use very widely 
during the war, when, perhaps, 100,000 women and 
girls used it continuously. It is compulsory, as has 
been stated, in certain industries. It is desirable 
in almost all, not only because of the comfort it 



confers, but also to keep out dust. Proper facilities 
for washing are equally desirable, though no order 
as yet governs this matter. Where chemicals are 
being handled such provision is essential. In greasy 
trades it may be said to belong to personal hygiene. 
A factory which lacks proper washing facilities is 
insanitary in the modern acceptation of that term. 
It is thus a danger to the persons employed in it 
and so a danger to the State. It is, however, 
inefficient, for good work cannot be done except in 
good conditions. Some employers are well aware 
of this, and in one factory no fewer than six bath- 
rooms with cubicles attached have been fitted up. 

With ambulance and first aid we have already 
dealt at length. But the value of rest-rooms re- 
quires to be insisted upon. Young workers are apt 
to feel faint at times or to suffer from minor ailments, 
and if they can retire for a few minutes their health 
is greatly benefited. The momentary rest relaxes 
the muscles and clears the brain and enables the 
man or woman to *' carry on " in better vigour. 
The same considerations apply to the provision of 
seats. Before this was done in munition factories 
many hardships were experienced. The Order came 
as a great relief, and the results fully justified it. 
The seats are to be used occasionally and not 
necessarily to work on, yet there has often existed 
a prejudice against them, more especially in the 
minds of foremen. 

Supervision is of extreme importance, and here 
there can be no doubt that training and experience 
are necessary. A properly qualified welfare worker 


is indeed a good investment for any firm, more 
especially if women are employed, for such an official 
stands outside the organization of the business, is 
impartial, and possesses special knowledge. Access 
is easy to the management, and complaints can be 
ventilated at once and redressed without delay. 

The welfare movement is still in its infancy, but 
it is a lusty infant. With its progress is bound up 
in no small degree the future of industry in this 
country. For it is in essence the recognition of the 
rights of employees to the full enjoyment not only 
of leisure, but also of work. The most far-seeing 
employers recognize this very clearly. Their in- 
fluence is gradually extending to those who are not 
capable of long views. 



The question of food in industry is one of the oldest 
in the world, but only in recent years has it received 
the scientific consideration which is necessary to lift 
it from mere speculation to exact knowledge. The 
result is that it is now as certain as anything can 
be that productive output, " in regard to quality, 
amount, and speed," is largely dependent upon the 
physical efficiency and health of the worker. These, 
in their turn, depend on nutrition, for food energy 
is spent not only in maintaining the tissues of the 
body and its heat, but also in doing work. 

This is so evidently true that it is difficult to 
understand why it has ever been disputed. The 
reason is probably that a certain type of employer 
worked on the principle that underfeeding or im- 
proper feeding of his workfolk was really no concern 
of his. They were free to act as they pleased ; if 
they became unfit for work he could replace them 
by other workers. 

Moreover, though they did not suspect it, these 
bad employers were robbing themselves by their 


% i^***;' 


very greed. Recent work of great care has shown 
that no amount of driving will extract good work 
from ill-paid labourers, whose food is necessarily 
reduced to a minimum. These men are unprofitable 
servants while at work, and more unprofitable still 
when they break down and become a burden on the 
community — including their employer. 

This the underfed and the improperly fed usually 
do at an early date. Their lack of stamina causes 
them to become fatigued very easily. The fatigue 
soon reacts on their digestive organs, setting up 
dyspepsia, which interferes again with what nourish- 
ment they were formerly receiving. A vicious circle 
is estabUshed and the man either becomes an 
invaUd at once or else takes to alcohol, by means of 
which he can perhaps whip himself to new efforts 
for a Uttle time. The end is the same in either 


What, then, is the necessary diet for the in- 
dustrial worker ? The question was asked — in great 
urgency — at the time of the pressure on munition 
works, and was answered generally thus : "A 
dietary containing a sufficient proportion and quality 
of nutritive material, suitably mixed, which is easily 
digestible, appetising, and obtainable at a reasonable 
cost." There are, as is well known, six essentials in 
any food supply : protein (which is the largest con- 
stituent of meat, eggs, milk, cheese, and is found in 
good quantity in oatmeal and other cereals) ; carbo- 
hydrate (i.e. the sugars and the starches, for example, 
potatoes and bread) ; fat, salt, vitamines (which are 
the curious and still rather mysterious Uving prin- 



ciples found in fresh food, but often absent from 
preserved food, without which life cannot be main- 
tained), and water. 

The vitamines deserve special mention, because 
their proper understanding is a thing of yesterday, 
and their value in warding off what are known as 
"deficiency diseases" is enormous. They are re- 
moved by certain processes of miUing — e.g. in the 
preparation of white flour and polished white rice. 
They are destroyed, too, by prolonged cooking, and 
are absent from foods preserved in tins. They are 
present in butter, dripping, and margarine when 
made from beef fat, but absent when it is made 
from vegetable fat. The potato contains them in 
sufficient quantity and makes an excellent food with 
bread and tinned stuffs. 

The type of diet required varies with the kind of 
work being accomplished. Thus hard labour which 
wears and tears the tissues demands a diet rich in 
substances capable of being used to repair waste — 
e.g. meat, cheese, eggs, and so on. In cold weather 
work fat is valuable because of the large amount of 
energy, heat for example, which it liberates. For- 
tunately the cheaper kinds of food, bread, margarine, 
porridge, milk, herrings, cheese, beans, onions, 
cabbages, swedes, and the cheapest cuts of meat 
provide all the requisite nourishment. 

It is quite certain that many workers are to-day 
getting a dietary which is not really effective. The 
reason for this is partly economic, but probably the 
fact that food has to be eaten away from home and 
in unfavourable surroundings in many cases is one 

H^^^l^^ . #■ -■ 


of the chief causes of the evil. The worker who is 
so situated either brings food with him akeady 
cooked and ready for eating or brings food which 
he can cook himself at the factory. Alternatively 
he goes to a local eating-house and takes his chance 
of a meal there. The objection to the first course 
is that a limitation is set on the kinds of food which 
may be cooked beforehand and eaten cold, and these 
are often unsuitable and but poorly nourishing. 
Moreover, when the weather is warm or the food is 
kept for any length of time in a hot workshop it 

Again, warmed-up food is generally not so 
nourishing as freshly cooked food, and unless the 
faciUties are ample it is often difficult for all the 
employees to prepare their meals efficiently. Under- 
cooking is apt to result, with consequent digestive 
and other troubles. The meals served in local 
eating-houses are often inferior, and give rise to 
troubles of the same kind. 

Now it is manifestly a great danger to industry 
that its workers should be compelled to struggle 
against discomfort and hardship in obtaining the 
very sources of their power ; and if, in addition, 
these sources are vitiated and disease set up the loss 
becomes a matter of profound anxiety. 

It was for these reasons that the Ministry of 
Munitions set itself the problem " to supply suitable 
food at a low price for large numbers of persons at 
specified times," and solved it by the industrial 
canteen. The problem exists to-day in every great, 
and in most small, industrial concerns, and its solu- 



tion is not less pressing now, in times of peace, than 
it was in times of war. 

We have already described how the most pro- 
gressive firms are handling this matter. As, how- 
ever, many firms have still to establish canteens, it 
may be useful to indicate the essentials of a success- 
ful undertaking. 

In the first place the site must be suitable. It 
should, above all things, be pleasant, for the effect 
on the mind of a dingy outlook, or a room hemmed 
in by buildings, is notoriously bad. There can be 
no sense of release and comfort, both important aids 
to digestion. The site, too, should be chosen in 
close proximity to electric, gas, and water mains, 
and be capable of easy and efficient drainage. It 
should on no account be at a great distance from 
the works. 

Of course, if all the workers can go home for 
meals the scheme will be a much less ambitious one 
than will be the case where meals must be provided. 
A buffet-bar in these circumstances will meet re- 
quirements. If, on the contrary, workers need their 
meals on the premises a definitely planned canteen 
will be necessary. The plan (Fig. 18) is drawn 
from that suggested by the General Health of 
Munition Workers Committee (Mi. D. N. Dyke, 
A.R.I.B.A., H.M. Office of Works). It affords 
accommodation for 100 diners. Plans have also 
been prepared for 500 diners. 

It is suggested that if the tables are made of 
good-quality wood no coverings should be used ; 
though a covering does improve the appearance of 

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the tables. Chairs are recommended in preference 
to forms, as they are more comfortable. Waste- 
paper baskets should be provided in order to secure 
tidiness. Rustless knife blades are also an advan- 
tage. Tea urns with earthenware linings are strongly- 

The floors have to stand a good deal of wear 
and tear, and should be of concrete finished with 
a granolithic face. Short barriers in front of the 
counters are advisable. 



The excellent effects of the physical training which 
so large a portion of the community received during 
the war have opened the eyes of all to the advantages 
which may be gained by care of the body. It is 
no exaggeration to say that this training rescued a 
large number of men from comparative decrepitude 
and saved an equally large number of boys from 
degenerating into ill-health. The effects are still 
evident, and the industry of the country is reaping 
advantage from them. 

It is for this reason that an influential body of 
men, including some of the most distinguished 
physicians and surgeons of the day, have launched 
a movement for national physical education. These 
reformers perceive that, in present circumstances, 
the hope of industry hes in health. Working hours 
are short, leisure hours proportionately longer ; if 
the work is to be done it must be in the hands of 
men and women who are fully capable in mind and 

Moreover, there is great need in this time for 



" the spirit of the game," the higher mental outlook 
which comes to the man, be he master or employee, 
who has devoted himself to the organized forms of 
exercise and learned the lesson of " playing for his 

The subject was dealt with recently at consider- 
able length by Surgeon-Commander Digby Bell, 
R.N., who lectured upon it before the Royal Society 
of Medicine, and gave it as his considered opinion 
that physical education is the very foundation of 
preventive medicine. This doctor served in the 
flagships of Sir John JeUicoe and Sir David Beatty 
and was in addition adviser in physical training to 
the Commander-in-Chief. 

His description of Ufe in the Navy during the 
war, of its effects on the men, and of the part played 
by recreation in improving matters, deserves to be 
read and considered by every doctor and employer 
of labour. For though conditions ashore, in work- 
shop and factory, are much less severe, yet there 
exists here also a monotony detrimental to human 
activity in the best sense of that term ; and so, by 
universal consent, detrimental also to work and to 
output. We quote Commander Bell's own words : 

Up North in the Grand Fleet the spectre we had to 
consider seriously was the possible onset of a depression 
due to the incessant nervous strain and the ghastly 
monotony. . . . Picture living in a home in which you 
can never get away by yourself for one moment's peace, 
but around you all day and night is a heaving mass of 
struggUng humanity, huddled together in an incessant 
noise on electrically lit mess-decks, with the very air 

' I 


you breathed pumped down to you artificially — then 
perhaps you can appreciate that sort of restless monotony 
which almost grips you by the throat. That this 
monotony cannot be said to have affected the morale 
of the sailor to any extent was due in great part to the 
ever-watchful care and forethought of those in charge 
of units and squadrons of the Grand Fleet. 

The lessons learned were that recreation and more 
recreation, of a simple and attractive nature, for all on 
board ship was wanted. It was always possible to keep 
the 10 per cent who excelled at games amused and 
energetic. They would roller-skate, box, dance, or do 
anything to keep themselves fit and cheery when 
weather and other conditions made landing on shore 
impossible. But it was the 90 per cent who were not 
endowed with this natural ability to excel at games on 
whom we had to concentrate in order to kindle a small 
spark of energy to shake off the dull and listless mood 
into which they were unconsciously drifting. 

The problem of the 90 per cent who are not 
gifted with the natural instinct for recreation is 
just as urgent outside the Services as it was in 
them. No employer of labour needs to be told of 
the difference between the "10 per cent man," 
the man who has developed in him the love of 
active recreation, and the " 90 per cent man," 
the man who has no such aptitude. The one 
is usually alert, clear-eyed, intelligent, a leader ; 
the other too often a mere machine, without light 
or enthusiasm. It is indeed true that " activity is 

Commander Bell laid down the plan of campaign 
of the new movement under three headings, and 


these we have reason to believe will form the basis 
of work : 

1. Activity developed by physical training. 

2. Energy developed by recreational training. 

3. Character developed by moral training. 

The first object is to secure continuity. The 
schoolboy obtains a certain physical education. 
But this too often stops when he leaves school. 
The lad goes into the world and begins work, and 
his leisure hours are heavy on his hands. He loses 
the aptitude for physical development and not 
infrequently becomes a "sloucher." This lad has 
joined the 90 per cent, and he represents on the one 
side a loss to industry and to the State and on the 
other a loss to himself. The subject is now exercis- 
ing the minds of the authorities, and has been 
referred to in recent publications by the Ministry of 
Health and Board of Education. 

The overwhelming success [one of these declares] 
which attended the general introduction of games 
behind the lines in France suggests that we have made 
far too little use of our national aptitude and love for 
games in the education and training of the young and 
as a means of wholesome recreation for the adult. 

Moreover, physical training must not only be 
continuous, it must be corrective. This point is of 
great importance, for it is now certain that all kinds 
of crippling disabilities can be removed or prevented 
or mitigated by judicious exercises — e.g. flat feet, 
weak ankles, knock knees, and so forth. 

This, however, is but the fringe of the subject ^ 


for you cannot " drill " men into good health. The 
difference between mere " drill " and recreation is 
fundamental. It is to the latter that our industries 
must look for the clear brains and strong muscles 
so necessary for their success. 

The *' game," indeed, is a moral as much as a 
physical training. Commander Bell declared : 

We must conclude that energy is dwindling because 
more people are willing to watch [a game] than to take 
part, and recreation does not attract. To put it in 
another way, 10 per cent wish to play and 90 per cent 
are content without. . . . The 90 per cent have never 
indulged systematically in sports and games principally 
because they have never had the opportunity. 

The new movement then aims at bringing oppor- 
tunity to those who have it not and who, being 
without it, cannot even value w^hat they have lost. 
The medical profession is aroused ; the Government 
is taking action, at least in the schools — and school- 
days now extend, under the new Education Act, to 
a much later period than formerly. It remains for 
employers of labour and representatives of labour 
to join forces with these others in order that 
the stamp of " National " may be set upon the 

The recreational side of each industry would be 
developed along the most useful lines and in relation- 
ship to that of every other industry. Does any 
employer suppose that he would not personally 
benefit by such a system ? Let him recall the fact 
that some of the most successful business enterprises 
in the country are leading the way in this respect 


and have promoted athletic clubs, laid out sport 
grounds, and installed swimming baths and provided 
instructors. Sir John Goodwin, the Director-General 
of the Army Medical Service, has recently referred 
to the wonderful changes wrought in soldiers in the 
convalescent depots in France. This change was 
produced by games and the spirit which games 
bring with them. That spirit is more than ever 
necessary to-day in our industrial world. 

There is still a further aspect of the matter which 
is apt to be lost sight of when the larger issues are 
being considered. Every industry exercises in some 
fashion a physical effect upon those engaged in it. 
Either one set of muscles are developed too greatly 
and at the expense of other sets or one organ of 
the body is overtaxed. This is at the bottom of 
what are called " industrial deformities," and also, 
to some extent, is responsible for industrial diseases. 
The evil tendency can be continuously corrected if 
imagination is brought to bear on the problem. 
Thus the " opponent " group of muscles can be 
developed by suitable exercise or, better still, by 
games chosen because they make calls upon certain 
muscles. The employee in this way is able, day by 
day, to oppose the tendency to ill-health and to 
keep his fitness in spite of his occupation. 

There is thus, if only we had the wit to see it, a 
special difficulty to be solved in each trade or calling. 
On the solution of it depends the working efficiency 
of that trade, and so, in a wider sense the working 
efficiency of the whole people. The professional 
man, for example, guards his health against a 


sedentary occupation by regular recreation chosen 
for him, very frequently by his medical adviser. 
The worker must be accorded a like advantage. 
The -industrial doctor in this country, following the 
example set in America, must come to the study of 
these needs. He must suggest the lines on which 
recreation ought to proceed in every branch of 
industry and he must superintend the carrying out 
of his ideas. 

It is absurd to suppose that so valuable a help 
towards efficiency will be resented by the workers 
of the country. On the contrary, if the experience 
of the war is worth anything, it will be welcomed. 
Those who have first-hand knowledge of the British 
soldier in hospital loiow how eager he was to regain 
his health, and how ready he was to follow any 
advice likely to lead to this result. As a worker in 
industry he will not prove less grateful for guidance 
and opportunity. 



The United States Public Health Service has re- 
cently pubUshed a book entitled Studies of the 
Medical and Surgical Care of Industrial Workers. 
Its l^eynote may be said to be that industrial 
medicine is no mere affair of employers and em- 
ployed, but, in fact, concerns the whole welfare of 
trade and, further, of the nation. It is a branch of 
preventive medicine, and as such demands the close 
attention of Governments as well as of the medical 
profession. Indeed it constitutes " a compromise 
between the ideals of medicine and the necessities 
of business." 

Another definition is worth quoting : industrial 
medicine is " the theory and practice of medicine 
appHed to the purpose of preventing and alleviating 
sickness and injury among industrial workers in 
order that they may enjoy the benefits of continuous 
productive employment." 

The report deals with 155 industrial estabhsh- 

ments. These employed 20 consulting physicians, 

68 whole-time physicians, 50 part-time, and 37 on 




call— i.6. 175 physicians in all, and in addition 13 
dentists were engaged. There were dispensaries 
at 137 of the establishments. These arrangements 
show very clearly that in the United States the new 
movement is under the control of the medical pro- 
fession. In the United Kingdom this is not so, and 
there can be no doubt that the United Kingdom is 
suffering from the omission. 

The American writer goes on to show in what 
direction and at what times the doctor ought to 
make his influence felt. He should be present at 
the beginning of the industry— i.e. at "industrial 
birth." He ought to select the workers suited to 
the work in hand. We have frequently urged this 
for our own industries, since there can be no greater 
economic calamity than that which follows the em- 
ployment of the physically unsuitable. Moreover, 
at present in order to maintain a personnel of 1000 
it is usual to engage 1000 new workers annually. 
Mr. Selby quotes one company which in the year 
1917 had a labour turnover of " somewhat over 
400 per cent." Every engagement represented a 
cost of about £1. It is easy to see, therefore, that 
careful selection \vill rapidly repay itself and in- 
crease the output of the industrial undertaking. 
Nor need this selection in any way miUtate against 
the interests of the employees, for no man desires 
to lose his health, and there are few men whose 
health will prevent them from engaging in all forms 
of industry. When the right kind of work has been 
found the man may devote himself to it in the 
comfortable knowledge that he is not thereby 



lowering his working capacity — his most valuable 


Again, the American movement recognizes the 
need for the doctor all the way through industrial 
life. * He must constantly supervise the health of 
the workpeople, and the surroundings in which they 
labour must be his especial care. We have already 
dealt with many aspects of this question, and have 
urged the necessity for those very measures which 
the United States has seen to be so essential and 
which she is busy carrying into effect — i.e. medical 
attention to personal ailments, tours of inspection 
of drainage and water supply, of Ughting and heat- 
ing and ventilation, instruction in personal (includ- 
ing dental) hygiene, and the like. As we have 
pointed out, some progress has been made in this 
country along these lines, but until the doctors bestir 
themselves and recognize their high calHng this can 
only be desultory. 

Finally, the doctor is required to save the in- 
dustrial worker when his health threatens to break 
down or when it has broken down. This may take 
the form of " out-patient treatment," or it may 
take the form of visiting the sick in their homes. 
Then when the worker has recovered to some extent 
" after-care " must be used so that he may be 
restored to full working capacity. 

This subject of after-care is a very big one. 
Possibly here the United Kingdom is not so far 
behind the United States as in other aspects of the 
industrial medical movement, for the war has taught 
us sharp lessons which we have learned almost in 


spite of ourselves. The Army could not afford to 
lose its human machinery, and so the orthopaedic 
surgeon was called in to make the best of each 
injured man, and what were called " curative work- 
shops " were evolved. In this a man obtained the 
necessary medical training of stiff joints and muscles 
while at the same time carrying on an occupation— 
e.g. turning a lathe. The Ministry of Pensions is 
carrying on the good work. Another aspect of the 
question, ''medical orthopaedics," was discussed 
and described in connexion with a plea for the 
after-treatment of tuberculous patients in village 
colonies. It was urged that, when a man has re- 
covered from the acute stage of his tubercular 
disease, he should not be sent back to his old 
occupation to relapse in a bad environment and 
infect others with his disease, but should be afforded 
the chance of suitable work in open-ak surroundings, 
at least until his lungs became sound again. 

A beginning has been made with this aspect of 
after-care work, and there seems to be little doubt 
that the movement will spread rapidly. The in- 
dustrial doctor will then be expected to decide as to 
whether or not a given employee who has been 
stricken down with illness is hkely to be able to 
come back to his old post, or requires to take up 
a different type of work. Our American writer, in 
showing how much need there is for work of this 
kind, recounts the case of two blind men found in 
the plant of a large electric motor company, and of 
51 crippled employees at the factory of an Ohio 
shoe company. 



The report goes on to lay it down that *' an 
estabUshment employing anywhere from 200 to 500 
people is warranted in having a dispensary ; that 
such an estabUshment is justified in having either 
a whole-time or part-time physician ; and that, if 
he be on a part-time basis, his services may advan- 
tageously be augmented by a trained female nurse 
or a person who has been taught to handle the 
routine work under his direction." Where 500 to 
1000 persons are employed, the part-time services of 
a dentist ought to be retained. 

Attention is especially drawn to the need for 
physicians trained in industrial hygiene, a need 
which is very great in this country at the present 
hour. Those who drift into the work are said to 
" drift with it," while those who act as " finger- 
wrappers " for the money it brings them are nothing 
but a reproach to the science. What is wanted are 
men " giving their brains and hearts to industry, 
striving at all times to better conditions among the 
working people and to benefit industry itself." The 
doctor himself is urged to " organize, deputize, and 
supervise." The report contains most admirable 
plans and drawings showing how dispensaries and 
medical quarters should be built. 

The following summary is given, and this is 
quoted in full to show how seriously the Govern- 
ment of the United States regards this branch of 
science and how wide is the scope given : 

1. Treatment of injuries in dispensary, home, or 
hospital by physician, attendant, or consultant, in- 


eluding orthopaedic and reconstructive surgery when 

2. Opinions as to disabiUties from injury and re- 
commendations as to compensation awards. 

3. Rehabilitation of impaired workers. 

4. Consultation and service, including dental, for the 
alleviation of ailments that become e\ddent during hours 

of employment. 

5. Assistance in obtaining skilled medical, dental, 
and nursing attentions when employees themselves are 
unable to procure them. 

6. Visits on sick absentees to assist in treatments, 
to render social aid, or to instruct. 

7. Regular factory inspection designed to uncover 
conditions that are inimical to health, and written 
recommendations to proper officials for their cor- 

8. Studies of the effects of methods, processes, and 
machinery operations upon health and body functions, 
relating to posture, eye-strain, monotony, speed, poisons, 
etc. Written recommendations to proper officials when 
effects are found to be harmful and advice to employees 
which will enable them to minimize the harmful results 
of processes from which hazards cannot wholly be 


9. Physical examinations of applicants for employ- 
ment and wTitten recommendations to emplojdng officers 
relative to applicants' fitness for work. 

10. Examinations of applicants for re-employment 
when the periods of absence warrant them. 

11. Examinations of employees when their shop 
efficiency falls off, unless the reasons are evidently not 
physical ; advice and treatment or aid in obtaining 
treatment to such as need it ; and wTitten recommenda- 
tions to foremen when deemed wdse. 



12. Examinations of employees returning to work 
after sickness or injury and written recommendations 
to emplojdng officers and foremen if employees are not 
fully restored. 

13. Examination of employees who do not feel well 
or do not appear well to their foremen or fellows : 
advice to employees when it is indicated and written 
recommendations to foremen if altered working condi- 
tions are essential. 

14. Examinations of workmen ceasing employment 
after having been exposed to special health hazards 
and explicit records of their conditions. 

15. Frequent examinations to follow up previous 

16. Monthly examinations of all process workers, 
those who may be engaged in any work that may in 
any way have ill effects, and of food handlers. 

17. Epidemiological service, including intimate co- 
operation wdth municipal health authorities. 

18. Health instruction by personal talks in the homes 
or factory, by lectures, posters, or pamphlets. 

19. Records of data that will assist in the prevention 
of accidents and sickness. 

20. Records of facts that will enable employers 
and employees to obtain equitable compensation ad- 

21. Records of information that will show the scope 
and value of all medical activities. 

22. Studies of facts and data mth the view to de- 
veloping scientific knowledge and usefulness. 

23. Contributions to scientific and trade publications. 

24. Attendance at meetings of scientific societies. 

25. Constant efforts to merit and retain the con- 
fidence of the employees and the approbation of the 


26. Frequent conferences T^ith those in authority. 

27. Co-operation with other establishments and local 
State and national health authorities. 

28. And, finally, the admonition to organize, deputize, 
and supervise. 


Absence of worker from fac- 
tory, records of, 67 
Accidents, and alcohol, 178 

and carelessness, 180 

and eyesight, 179 

and fatigue, 177 

and lighting, 178 

and temperature, 178 

as cause of national loss, 98 

at night, 177 

personal factor in, 176, 180, 

prevention of, by Safety 
First, 169, 182 

speed of output and, 176 

theories of causation of, 181 

to eye, 147 

to women, 177, 178 

types of, 169 
Aid, first, 183 et seq. 

first, for young employees, 91 
Air, cool and hot, effects of, 110 

damp, 110 

in ventilation, 107 
Alcohol, and accidents, 178 

and tuberculosis, 137 
Ambulance room, 184 et seq. 

equipment of, 188 

heating of, 188 

personnel of, 188, 189 
America, methods of dealing 
with Miners' Blindness in, 

programme of industrial 
medicine of, 119, 227 et 

venereal disease in, 139 

Approved societies and expen- 
diture on sickness, 97 

Attendance at continuation 
classes, 90 

Baths for young employees, 90 
Benefit, sickness, per annimi, 

Blasting, dust from, and tuber- 
culosis, 166 
Blindness, Miners', 153 et seq. 
Blood ])oisoning in first aid, 

Boys, cleanliness of, 91 
clothing of, 91 
deformities among, 92 
diseases of, 92 
employment of, 91 ef seq. 
Broken time at work, records 
of, 67 

Camps for young employees, 91 
Canteens in factories, 210, 217 
Carelessness and accidents, 180 
Clothes of boy workers, 91 
Clothing, of workers and out- 
put, 127 
protective, 210 
Cloth trade, danger of tuber- 
culosis in, 45 
Coal dust as preventive of 

tuberculosis, 162 
Consumption, as cause of re- 
jection of unfit workers, 
42, 45 
in boy workers, 91 
prevention of, in factories, 53 




Convalescent homes for young 

employees, 91 
Cost of medical examination 

saved in a year, 134 
Cuts and bruises, 176 
Cyclegraph, the, 102 

Deformity, as cause of national 
weakness, 49, 50 

in boy workers, 92 
Dental care, of workers, 81 

of young workers, 90 
Diet, ideal, 214 
Disease, affecting output, 24 

in various trades, 45, 48 

price of, 94 
Doctors, in works, 27 

need of, in industry, 62 
Dust, and tuberculosis, 161 

protection against, 167 

stone, compared with coal 
dust in tuberculosis, 161 

the peril of, 160 

types of, in producing dis- 
ease, 164 

Education Acts and industry, 

60, 87 
Electricity, lighting by, 152 
Electric railway employees and 

influenza, 117 
Employers, and village colonies 
for tuberculosis, 56 
value to, of medical exami- 
nation of workers, 54 
Employment of tuberculous 

workers, 55 
Energy, waste of, in superfluous 

movement, 100 
Examination, medical, of young 
employees, 90, 91 
of older employees, 54 
Exercise, and tuberculosis, 135 
remedial and compensatory, 
Eye, accidents to, 147 
sight and accidents, 179 
strain and efficiency, 149 
strain and lighting, 148 
strain, prevention of, 150, 

Fans in ventilation, 110, 126 
Fatigue and accidents, 177 
Feet, swollen, of women 

workers, 81 
First aid, 183 et seq. 

and blood poisoning, 184 
dressings in, 184 
for young employees, 91 
First-aid boxes, 184 
Floors and foot troubles, 82 
Following up lost workers, 78 
Food of the worker, 213 et seq. 

Games as helps to fitness, 224 

Gas, lighting by, 152 

Gases, workers in, free from 
colds, 117 

Girls, and heavy work, 76 
cause of their leaving em- 
ployment, 75, 76 

Glare, danger of, in lighting, 

Grades of workpeople, 45 et 

Guards on machinery, 171 

Headache among women 

workers, 81 
Heart, diseases of, as cause of 
unfitness, 45, 57 
diseases of, in boy workers, 92 
Hours of industry, 30 
short or long, 33 
systems of, 35 
House of Commons, ventila- 
tion of, 113 
Housing, and lost time, 66 

and tuberculosis, 135 
Human machinery, 38 

Incandescent light, 153 

Incentives to work, 68 

Index of fitness for grading 

workers, 40 
Indoor trades compared with 

outdoor, 46, 47 
Industrial fatigue, 1 et seq. 

and accidents, 177 

and lost time, 67 

and output, 20, 21 

in women, 83 



Industrial Fatigue Board, 104 
Influenza and the worker, 117 

Juvenile employment, 60, 87 
et seq. 

*' Killing Diseases," the, 62 

Labourers and skilled workers, 

diseases of, 48 
Length of service among 
women, effect of, on work, 
Lighting, and accidents, 179 
and eye-strain, 148, 151 
good system of, 154 
Loss of employment througli- 

sickness, 97 
Lost time, 63 
and housing, 66 
and industrial fatigue, 67 
and transport, 66 
and unfitness, 66 
Lost worker, the, 71 
classes of, 75 

Married women as workers, 

Medical examination of em- 
ployees, 28 

Metal workers, phj'^sique of, 

Miners, blindness of, 153 
physique of, 40 

Mines, ventilation of, 129 

Motion, study of, 99 

National Service Boards, re- 
port, 38 et seq. 
report, fallacies in, 38 
Night work and accidents, 

Noise in industry, 191 et seq. 
effect of, 193 
elimination of, 192 
experiments on, 198, 199 
Noise, state of industry in re- 
gard to, 197 
Nystagmus, miners', 153 et seq. 
miners', economic aspect of, 

Occupation, suiting the worker 

to, 51 
Orthopaedic surgery in in- 
dustry, 51 
Outdoor and indoor trades, 46, 

Output, and ventilation, 107, 
124, 126 
low in evening, 18 
low in morning, 17 
speed of, and accidents, 176 
unprofitable, 15 
Overtime, mistake of, 15 
Oxygen in ventilation, 108 
Ozone as preventive of in- 
fluenza, 117 

Photography and motion study, 

Physical training, 221 et seq. 
and character, 223 
and tuberculosis, 136 
for young employees, 90 
Plenum system of ventilation, 

Price of disease, the, 94 
Printing trade, consumption in, 

Rand Mines, ventilation of, 

Reaction time, 10 
Rejection of unfits, causes of, 

Respirators in dusty trades, 

Rest pauses and lost time, 65 
Rest rooms in factories, 211 
Rheumatic fever as cause of 

unfitness, 57 
Rheumatism and output, 24 
Rickets in boy workers, 92 

Safety Committees in works, 

constitution of, 172 

duties of, 173 
Safety First, 168 et seq. 

methods of, 169 

propaganda for, 174 
Seats in factories, 211 


Shifts, one-day break system, 

two-day shift system, 35 
five-day week system, 36 
Sickness, economic loss from, 

Silica dust and consumption, 

Skilled workers, diseases of, 48 
Skin, in ventilation, 109, 127 
Speed of output and accidents, 

Stereoscopic camera in motion 

study, 103 
Stone -cutters' phthisis, 161 
Syphilis in industry, 140 
as cause of rejection of un- 
fits, 42, 57 
Systems of hours of work. See 


Tailoring trade, danger of con- 
sumption in, 45 
" Taylorism." See Motion 

Teeth, bad, in industry, 80 
of boy workers, 99 
output and, 24 
Temperature and accidents, 

Tinplate industry and ventila- 
tion, 120, 121 
Trades, and disease, 45, 46, 47 
classification of, in relation 
to motion study, 104 
Transport workers, 66 
Tuberculosis, 130 et seq. 
and alcohol, 136 
and exercise, 135 
and housing, 135 
and transport, 135 
as a cause of unfitness, 45 
deaths from, 131 
medical examination in con- 
nexion with, 132 
prevention of, in factories, 
63, 54 

Tuberculosis (contd.) — 
spread of, in industry, 135 

Venereal disease, 138 et seq. 
and education, 143 
in America, 139 
prevention of, 143 
Ventilation, and output, 107 et 
seq., 124 
and prevalence of disease, 

ideal, 112 

in tinplate industry, 120, 121 
Verminous state of boy 

workers, 91 
Village colonies for consiunp- 

tives, 55 
Vision of boy workers, 92 
Vitamines in diet, 215 

Warming a room, ideal method, 

Washing fticilities for workers, 

Water, drinking, for workers,. 

Welfare work, 205 et seq. 
and food, 209 
as test of employers, 208 
in dusty trades, 209 
Orders regarding, 205 
"White Plague." See Tuber- 

culosis, 130 
Women workers, accidents to, 
177, 178 

Young employees, 87 et seq. 
attendance at continuation 

classes, 90 
baths for, 90 

convalescent homes for, 91 
dental work for, 90 
first-aid work for, 91 
meals for, 91 

medical examination of, 89 
physical training of, 90 
supervision of, 90 









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